Evaluation of the pacing rate response to treadmill exercise using computer simulation of a temperature-based, rate-adaptive algorithm

A temperature-based, rate-adaptive, pacing algorithm was developed to benefit the patient. Rate-adaptive pacemakers use a physiologic parameter to identify the need for increased pacing rate. Parameters that have been clinically investigated include venous pH, Q-T interval, respiration, body motion, and blood temperature. The objective of this study was to provide pacing rates resembling normal heart rates in response to various levels and types of activity. A rapid response time (within 30 s of exercise onset) was also sought. Blood temperature, which reflects metabolic activity of all regions, was selected as the physiologic parameter. Right ventricular blood temperature was recorded in 25 patients with implanted Kelvin 500 pacemakers (Cook Pacemaker) during rest and treadmill exercise. The patient population included 16 men and 9 women, age 44-81 years (mean = 72). Indications for pacing were sinus node disease, atrioventricular block, and atrial fibrillation with slow ventricular response. The temperature changed with physical activity and emotional stress. Temperature typically dropped briefly at exercise onset, increased with continued exercise, and returned to the resting level after exercise. These components were employed in developing the temperature-based rate-adaptive algorithm, which was designed to use the rate of temperature change (dT/dt), temperature change (delta T), and baseline temperature (T). The temperature profiles were used to produce simulated pacing rates as determined by the algorithm. The drop in temperature at onset of activity was utilized to provide a rapid increase in pacing rate. As dT/dt became positive and delta T increased, pacing rate was further increased.(ABSTRACT TRUNCATED AT 250 WORDS)