Comparative evaluation of rate modulation in new generation evoked QT and activity sensing pacemakers

Two new generation rate adaptive pacemakers, the Rhythmyx (Vitatron) using the evoked QT interval and the Legend (Medtronic) using vibration as indicators of metabolic demand, were compared for rate adaptive characteristics during different forms of exercise. While both showed improvements over previous generation pacemakers, they still show deficiencies in some aspects of rate modulation. Rhythmyx was slow to respond to changes in metabolic need and showed an "over-shoot" with increasing pacing rate on cessation of exercise. Legend was quick to adapt rate at beginning and end of exercise but showed a plateaus of rate modulation during the period of slowly increasing workload. Legend also showed only modest rate adaptation to changes in treadmill gradient and to bicycle ergometer exercise. Further developments in pacemaker technology are required if physiological rate adaptation to exercise is required.