given the lower FFRS thresholds with bipolar sensing, bipolar sensing is superior in avoiding FFRS compared with unipolar sensing. No differences were found in terms of amplitude thresholds and timing characteristics with patients supine, standing and at peak exercise. Thus, measurements made in the supine position are basically sufficient to predict the presence/absence of FFRS under different conditions.

'2:1 lock-in' is a typical form of MS failure in patients with atrial flutter and the mechanism is closely linked to the typical atrial sensing windows.

It is thought that increasing catecholamine levels in the heart are partly responsible for shortening of the repolarization time and so indirectly for the pacing behavior of the QT driven pacemaker. Adrenaline and noradrenaline (NA) plasma levels were determined at rest, during symptom-limited exercise, and during recovery more than 1 month after the implantation of a 919 or a Rhythmyx pacemaker (Vitatron, The Netherlands) in eight patients (age 54-85 yrs). Significant increases were detected in NA level (from 0.57 +/- 0.23 ng/mL to 2.15 +/- 0.76 ng/mL), but not in the circulating adrenaline level. The correlation coefficient of the mean pacing rate and the mean NA level during exercise and recovery was 0.963 (P less than 0.0001), the correlation coefficient with the mean oxygen consumption was 0.888 (P less than 0.01). No correlation with the adrenaline level was observed. The correlation coefficient of the changes of pacing rate and the changes of NA level during exercise and recovery was 0.882 (P less than 0.005). The pacing rate of the new generation of QT driven pacemakers is closely correlated with the noradrenaline spillover in the plasma, not with the adrenaline level. A short delay (less than 1 minute) is observed in the adaptation.

The Topaz model 515 (Vitatron B.V.) is a dual sensor rate responsive pacemaker for single chamber stimulation. It can be driven by activity counts (ACT) and QT interval measurements. Inappropriate rate modulation due to one sensor can be corrected by "sensor cross-checking." It was implanted in ten patients (20-86 years) of whom seven had complete heart block and atrial arrhythmias. After implantation T-wave amplitude ranged from 0.9 mV-3.5 mV. T-wave sensing ranged from 88%-99% in 9/10 patients at the follow-up of 3 weeks. Eight patients remained in default setting of the activity threshold, after evaluation with a short walking test. An exercise test was performed on all patients. In one test, QT sensing was marginal because of lead implantation in the right ventricular outflow tract. Therefore, this pacing rate was only modulated by ACT sensing. All others were tested with equal contribution of information from both sensors (ACT = QT). In 7/9, rate response was satisfactory. When the treadmill was repeated with ACT in five of these seven patients, rate generally accelerated too fast. In one patient the setting was adjusted to "QT > ACT," because of inappropriate acceleration due to activity sensing, in another it was adjusted to "QT < ACT" because of delayed response to activity. The pacing rate and the ACT during treadmill tests in "QT = ACT" mode were more closely correlated in the first 3 minutes, compared with the last 3 minutes. We feel that rate modulation with this new pacemaker is adequate. Sensor blending and sensor cross-checking are of clinical importance.

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