When sick sinus syndrome presents as an inadequate heart rate response to physical activity — chronotropic incompetence — with clear exercise-related symptoms, standard pacing approaches may not fully address the patient's functional needs. A specific pacing strategy is indicated for this clinical scenario.
The patient has sick sinus syndrome manifesting as chronotropic incompetence — the heart rate fails to rise appropriately with exercise — producing clear, symptomatic impairment during physical activity. This combination requires a pacing mode that can adapt to the physiological demands of exertion.
Current evidence supports a dual-chamber pacing modality with rate-responsive capability as the preferred approach in this setting. The complete selection criteria, programming parameters, and follow-up recommendations are available in the full protocol.
DOI: 10.1093/eurheartj/ehab364
In patients who present chronotropic incompetence and have clear symptoms during exercise, DDD with rate-responsive pacing should be considered.
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