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Rate Response Flashcards

1
Q

What is the term for when a patient’s heart is unable to modulate/change the rate in response to increased activity or metabolic demand?

A

chronotropic incompetence

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2
Q

What is the purpose of Rate Response?

A

to modulate/increase the HR to meet metabolic demand d/t increases in activity

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3
Q

What are the 3 steps taken by the rate response feature when adjusting the patient’s HR?

A
  • estimates metabolic need
  • calculates pacing rate
  • optimizes or adjusts according to sensed motion
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4
Q

How does the rate response feature estimate the metabolic needs of a patient?

A
  • uses an accelerometer attached to the circuit board of the device
  • flexing of accelerometer produces an electrical signal
  • measures amplitude and frequency q2 seconds
  • only measures signals above activity threshold
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5
Q

What is the nominal setting for the activity threshold value?

A

medium/low

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6
Q

What calculation is used to estimate the upper sensor rate?

A

(220 - pts age) x 80%

ex: (220 - 40y/o) x 80% = 144bpm

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7
Q

What effect does increasing the ADL or Exertion response value have?

A
  • makes it harder for patient to increase HR

- increasing these values means more sensor counts are required to increase the HR

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8
Q

What does the Activity Acceleration value in the Rate Response feature do?

A
  • determines how quickly the pacing rate increases to the target sensor rate at the onset of strenuous activity
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9
Q

What does the Activity Deceleration value in the Rate Response feature do?

A
  • determines how quickly the pacing rate decreases to the target sensor rate when the patients activity stops
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10
Q

Which feature monitors and adjusts the ADL and Exertion rate response levels according to the patients activity?

A

Rate Profile Optimization

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11
Q

In which patient population(s) should Rate Profile Optimization be turn off?

A
  • extremely sedentary or extremely active patients

- need to adjust rate response manually

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12
Q

How often does Rate Profile Optimization adjust rate response values?

A

once a day

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13
Q

What type of activity and how much time should a patient with an ADL response value of 3 spend at or near the ADL rate?

A
  • moderately active

- 30 min

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14
Q

How much time should a patient with an ADL response value of 1 spend at or near the ADL rate?

A

-8 min

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15
Q

What type of activity and how much time should a patient with an ADL response value of 4 spend at or near the ADL rate?

A
  • more active

- 60 min

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16
Q

How much time should a patient with an ADL response value of 5 spend at or near the ADL rate?

A
  • 100 min
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17
Q

How much time should a patient with an ADL response value of 2 spend at or near the ADL rate?

A
  • 15 min
18
Q

How much time should a patient with an Exertion response value of 1 spend at or near the USR?

A
  • 21 min
19
Q

How much time should a patient with an Exertion response value of 2 spend at or near the USR?

A
  • 21 min
20
Q

How much time should a patient with an Exertion response value of 3 spend at or near the USR?

A
  • 21 min
21
Q

How frequent and how much time should a patient with an Exertion response value of 4 spend at or near the USR?

A
  • more frequent

- 70 min

22
Q

How much time should a patient with an Exertion response value of 4 spend at or near the USR?

A
  • 133 min
23
Q

What are the nominal settings for the ADL and Exertion response values?

A

3 for both

24
Q

How does the rate profile optimization algorithm work?

A
  • collects daily sensor rate profile and merges data into a long-term sensor rate profile
  • compares daily and long-term Sensor Indicated Rate Profiles (SIRP) to the Target Rate Profile to assess the performance of the currently programmed values
  • if SIRP = target profile or the daily and long-term SIRP contradict each other, NO rate adjustment will occur
25
Q

What programming change should be made if the patient’s Sensor Rate profile is showing a higher percentage of time spent pacing than the target profile?
- meaning the patient’s HR is spending more time in the ADL or Exertional zones than recommended per the target rate profile

A
  • program rate response to be less sensitive which adjusts the ADL and/or exertional setpoints to make it more difficult for the patient to reach the target profile rate
  • slope becomes less steep and patient requires more aggressive stimulation to reach their target HR
26
Q

What programming change should be made if the patient’s Sensor Rate profile is showing a lower percentage of time spent pacing than the target profile?
- meaning the patient’s HR is not spending as much time in the ADL or Exertional zones than recommended per the target rate profile

A
  • program rate response to be more sensitive which adjusts the ADL and/or exertional setpoints to make it more easier for the patient to reach the target profile rate
  • slope becomes steeper and patient reaches their target HR sooner with less stimulation
27
Q

What are the smallest/largest values for both the ADL and UR setpoints in Rate Response?

A
  • ADL: 5 - 80

- UR setpoint: 15 - 180

28
Q

What does it mean when the ADL and UR setpoints are set to 5 and 15 at interrogation?

A
  • pt is mostly sedentary and RPO has reduced the setpoints to the minimum settings to make it easier for the patient to reach their target HR
  • change the Activity Threshold by one to make the sensor more sensitive and require less stimulation for activation
29
Q

What is the difference between the UTR and the USR?

A
  • UTR is the highest rate the PM will track the atrium and pace the ventricles
  • USR is the highest rate, rate response will pace in response to physical activity
30
Q

What shape does the ideal rate histogram show when evaluating rate response performance?

A

want the rate histogram to have a staircase like distribution/appearance

31
Q

`What should be reviewed when evaluating Rate Response in a patient with a mix of pacing and sensing?

A

evaluate/review the Sensor Indicated Rate Profile for rate distribution (should look have staircase appearance)

32
Q

`What should be reviewed when evaluating Rate Response in a patient is primarily paced?

A

evaluate/review the Rate Histogram for rate distribution (should look have staircase appearance)

33
Q

How do you evaluate the activity threshold of a patient while in the clinic to determine the rate response setting that will not trigger rate response pacing at rest?

A
  • have patient rest for about 10 min
  • if HR is 50 bpm or greater, change the activity threshold to be less sensitive (low to med low)
  • if pacing at or below the LR, change activity threshold to be more sensitive (med low to low)
  • observe pt after change is made
34
Q

What is the nominal ADL rate setting?

A

95 bpm

35
Q

What are the 4 programing options for the activity threshold settings?

A
  • low
  • med/low
  • med/high
  • high
36
Q

How long after implant of a transvenous pacemaker is rate response enabled and why?

A
  • automatically enable 30 after implant d/t the implant detect algorithm
  • rate response is one of 5 algorithms that won’t turn on until after implant detect is turned off or completes its polarity check 30 mins after implant
37
Q

How long after implant of an ICD is rate response enabled and why?

A

rate response is automatically turned on once VF detection is programmed to On

38
Q

What affect does increasing the ADL/UR setpoint value have?

A

increasing the setpoint will require more sensor counts to increase the HR to the target zones, meaning it will take more action/activity on the part of the patient to increase their HR

39
Q

What happens to the activity slope when the setpoint value is increased?

A
  • the slope becomes less steep, making it harder for the patient to reach the target HR zone
  • requires more effort to increase the HR
40
Q

What value determines the minimum number of sensor counts needed to reach the ADL rate?

A

the ADL setpoint

41
Q

What value determines the minimum number of sensor counts needed to reach the USR?

A

the Exertion setpoint

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