Heart rate monitoring in implanted pacemakers.

Increasing pacemaker memory allows integration of heart rate monitoring into the pacemaker. Two main methods can be distinguished. 1. Heart rate monitoring in histograms. 2. Heart rate monitoring in the time domain (heart rate holter). Method 1 is useful in antitachycardia and diagnostic pacemakers when short specific events must be detected (tachycadia, bradycardia). For the analysis of a rate adaptive pacemaker this method is less appropriate as it does not give any information about the dynamics of rate changes or its time relations. For this purpose Method 2 will give more information about the functioning of the pacemaker as it does not only store the heart rate but also the timing of the heart rate so that changes in heart rate can be correlated to the activity of the patient. An algorithm was developed to store the average heart rate over 7.8 minute periods in a pacemaker. On interrogation of the pacemaker the information will always reveal the heart rate over the 24 hours prior to interrogation. This monitor can also be temporarily programmed to store the average heart rate in 20 second intervals to monitor the response to an exercise test for a period of 1 hour. The time needed for a standard follow-up procedure of a rate adaptive pacemaker can be dramatically reduced to a value close to the follow-up time of a standard VVI pacemaker.