PEAK ENDOCARDIAL ACCELERATION-BASED CLINICAL-TESTING OF THE BEST DDDRPACEMAKER

The peak endocardial acceleration (PEA, unit g) shows a near correlati on with myocardial contractility during the isometric systolic contrac tion of the heart (dP/dtmax), with sympathetic activity and, thus, wit h physiological heart rate modulation. The (Biomechanical Endocardial Sorin Transducer (BEST) sensor is incorporated in. the tip of a pacing lead and measures PEA directly near the myocardium. In an internation al study, the lead was implanted with the dual chamber pacemaker Livin g-1 (Sorin) in 105 patients. The behavior of the PEA signal was tested under conditions of physical and mental stress and during daily life activities by 24-hour recordings of PEA (PEA Holter) at 1 to 2 months and approximately 2 year after implantation. Implantation of the BEST lead was performed without complications in all patients. The sensor f unctioned properly in the short- and long-term in 98% of patients. Alt hough PEA values differed from patient to patient, the values closely reflected the variations in sympathetic activity due to physical and m ental stress in each patient. During exercise and during daily life ac tivities a close correlation between PEA and heart rate was observed a mong patients with normal sinus rhythm. Peak endocardial acceleration allows a nearly physiological control of the pacing rate.