Sensor Technology for Rate-Adaptive Pacing and Hemodynamic Optimization

Rate-adaptive pacing has become a standard for the majority of patients requiring permanent pacing. Even if rate-adaptive parameters are not initially required, having it as a programmable feature for patients who may develop chronotropic incompetence over time provides important flexibility for the patient and caregiver. Although multiple sensors have been utilized, accelerometer-based rate-adaptive pacing is the predominant sensor and minute ventilation also remains an important sensor for rate-adaptive pacing. Others such as peak endocardial acceleration and right ventricular impedance-based rate-adaptation are also used either in permanent pacemakers or cardiac resynchronization therapy (CRT) devices. Programming rate-adaptive sensors requires special considerations for most patients and a thorough familiarity with programmable parameters to adjust the sensor is important. Sensors initially used only for rate-adaptive pacing are now being incorporated into CRT devices for the purposes of auto-optimization of hemodynamics. Although there is limited availability of hemodynamic sensors in CRT devices at this time, this will undoubtedly be increasingly important.