Clinical Evaluation of Chronotropic Incompetence: Implications for Rate-Adaptive Pacing

The introduction of sensor-based rate-adaptive pacemakers in the 1980s revolutionised the practice of cardiac pacing 1. In particular, the availability of a means to restore heart rate responsiveness focused attention on the physiological importance of providing symptomatic patients with as normal a chronotropic response as possible. Thus, the recognition of chronotropic incompetence became a true clinical concern, and ultimately led to a new indication for implantation of cardiac pacemakers.