RATE-DROP RESPONSE PROGRAMMING

Effective programming of the rate-drop response algorithm requires car eful attention to the heart rate and blood pressure responses seen dur ing diagnostic tilt testing. In order to undertake effective programmi ng, additional tilt testing procedures may be necessary, and it is vit al that the protocol should be identical on each occasion and very car eful note taken of exact times of onset of symptoms and relative timin g of onset of changes in heart rate and blood pressure. The algorithm settings in the Thera DR generator as delivered (factory or ''shelf'' parameter settings) must be considered nontherapeutic (an unusual situ ation for a pacemaker algorithm) and will require adjustment for each individual patient. Effective therapeutic settings are likely to resul t in an excess of pacing interventions; these, however, tend to be les s symptomatic than the syncope or presyncope suffered by the patient a nd are generally well tolerated or not noticed.