Follow Up of Patients with Rate-Adaptive Pacemakers C.P. LAU! Introduction Rate adaptation to exercise and non-exercise requirements is an important means by which a physiological pacing system can optimise haemodynamics [1, 2], symptomatology [3, 4], quality of life [5], hormonal function [6] and circadian blood pressure variability [7] in patients with bradycardia. However, in order for an implantable sensor to function optimally, judicious programming and follow up of these patients are mandatory. Besides routine assessment of battery and electrode status like the follow up of all conventional pacemaker recipients, special attention to the sensor and algorithms of rate adaptation will be necessary (Table 1). Clinical Assessment Symptom assessment is perhaps the most important aspect of follow up of patients with rate-adaptive pacemakers. Adverse symptoms such as palpitations may suggest Table 1. Follow up of patients with rate-adaptive pacemakers. Types Details Clinical Symptoms (e.g., palpitations, breathlessness, angina) Well-being Programming Special problems Haemodynamics and exercise capacity Lower and upper rates Speed of rate adaptation at onset and termination of exercise Matching sensor level to different workloads Choice of A V interval, post-ventricular atrial refractory period and upper tracking rate in DDDR pacemakers. Pacemaker syndrome, myopotential interference, pacemaker- and sensor-mediated tachycardias 1 Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong E. Alt et al. (eds.), Rate Adaptive Cardiac Pacing © Springer Verlag, Berlin Heidelberg 1993