Inappropriate rate response in a leadless pacemaker due to automatic rate profile optimization

Abstract

A three-axis accelerometer sensor is incorporated in a leadless pacemaker (Micra TM , Medtronic Inc ) for rate adaptation. Three sensor setpoints at lower rate (LR), activity of daily living rate (ADLR), and upper rate (UR) are used to convert detected acceleration to a desired rate response. We describe inappropriate rate acceleration at rest and during chest physiotherapy in a sedentary elderly patient with leadless pacemaker. The underlying mechanism and various programming options are discussed.

Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS

“…30 Indeed, activity rate was proportional to workload (r = 0.86) with optimal adjustments in 83% of patients in a recent trial. 31 In selected cases vector changes and manual programming might be helpful.…”