Maximal rate response in a permanent pacemaker during chest physiotherapy.

Rate-responsive pacing is designed to allow a near-physiologic heart rate response to patient activity. One means of generating the desired response has been achieved with the use of pacemakers that respond to vibration generated by skeletal muscle activity. In this article, we report a case of increased paced rate in an activity-sensing rate-responsive pacemaker caused by the sensing of skeletal muscle vibration during chest physiotherapy. Potential clinical complications and possible solutions to this problem, as well as significant aspects of nursing care, are discussed with respect to patients with rate-responsive pacing devices.