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Updated: Jul 29, 2026
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Improved delivery of rate-adaptive pacing using an impedance-derived contractility sensor in high-intensity exercise:
William Thomas Christopher Procter1,2, James Elliott2, Abdul H Butt2
1Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK.
Abstract:
Effective rate-adaptive pacing may be difficult in the presence of atrial fibrillation (AF), and is important during high-intensity exercise. This case presents a 74-year-old elite cyclist with AF and a biventricular pacemaker after atrioventricular (AV) node ablation. He reported sudden breathlessness due to heart rate drops, caused by breaching the artefact threshold on the minute-ventilation sensor. He was exchanged to a generator with an impedance-derived contractility sensor (closed-loop stimulation), resulting in resolution of symptoms, and no further rate drops. This is the first description of the utility of closed-loop stimulation in high-intensity exercise.
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