Related Experiment Video
Updated: Jan 8, 2026

Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
Published on: July 21, 2023
Cardiopulmonary Exercise Testing to Troubleshoot Rate-Responsive Pacing in an Athlete With Acquired Sinus Node
Shreyas Venkataraman1, Krasimira Mikhova1, Douglas Hall1
1Washington University in Saint Louis, St Louis, Missouri, USA.
Background:
Athletes with sinus node isolation can become fully dependent on sensor-driven pacing. Default accelerometer settings may underperform during exertion.
Case Summary:
A 73-year-old former collegiate athlete developed exertional dyspnea after Cox Maze IV procedure; postoperative testing showed sinus node isolation, and he received a dual-chamber pacemaker. A cardiopulmonary exercise test (CPET) revealed a blunted chronotropic response, with his heart rate plateauing at 105 beats/min (device activity setpoint). A repeat CPET with real-time programming (lower activity threshold, higher activities of daily living rate, rate-adaptive atrioventricular delay/limits) restored rate escalation within weeks, with symptom resolution and peak oxygen consumption volume improving from 87% to 102% predicted.
Discussion:
CPET can both diagnose device-mediated chronotropic limitation and provide a physiologic target for on-table pacemaker programming in highly active patients, where activity sensors often miss intermittent workloads.
Take-Home Message:
This case underscores the limitations of activity-based sensors in athletes and highlights the utility of CPET in diagnosing and personalizing pacemaker programming to restore functional capacity.
Related Concept Videos
ECG Interpretation of Arrhythmias I: Sinus Arrhythmias
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism,...
Decreased pulse rate
There are specific risk factors that can elevate the likelihood of developing bradycardia. Advanced age is a significant factor, with...
Dysrhythmias III: Characteristics of Dysrhythmias
Dysrhythmias IV: Characteristics of Bradyarrhythmias
Conduction System of the Heart
The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...
Conduction System of the Heart
This system relies on the unique properties of nodal and Purkinje cells:...

