Is a Dual-Sensor Pacemaker Appropriate in Patients with Sino-Atrial Disease? Results from the DUSISLOG Study

Background: Rate‐responsive pacemakers (PMs) are often supplied with accelerometer (XL) and minute ventilation (MV) sensors to provide a physiologic rate response according to patient needs. No information is available about the real benefit of dual‐sensor rate‐responsive pacing on the daily life of patients. Methods: DUSISLOG (Dual Sensor vs Single Sensor comparison using patient activity LOGbook) is a two‐arm prospective, randomized, multicenter study that enrolled 105 patients who received a rate‐responsive PM (Insignia ®, Guidant Corp.). After 1 month of DDD pacing at 60 ppm lower rate, a single sensor (XL or MV, randomized) was activated for 3 months at the manufacturer's suggested nominal settings, followed by a 3‐month period with dual sensors optimized with automatic response. During the last month of each period, the following data concerning patient physical activity were retrieved from PM diagnostics (Activity Log): mean percentage of physical activity, mean intensity of activity. Quality of life (QoL) scores and 6‐minute walk test (WT) were also recorded. Results: Single‐sensor rate‐responsive pacing resulted in symptomatic benefit equally with XL and MV sensors while no additional benefit was found using dual sensor. In a subgroup analysis, patients (17%) with marked chronotropic incompetence and with 0% atrial sensing received benefits from single sensor with an additional advantage from sensor (QoL: +21 ± 14% P < 0.05; WT: +17 ± 7% P < 0.02). Conclusion: In most patients with rate‐responsive devices, a single sensor is sufficient to achieve a satisfactory rate response. A dual sensor combination and optimization provides an additional benefit only in a selected population with an advanced atrial chronotropic disease.