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Heart Rate Changes during Acute Mental Stress with Closed Loop Stimulation: Report on Two Single‐Blinded, Pacemaker Studies

Background: Mental stress affects hemodynamic properties of the heart in patients indicated for a pacemaker, therefore highlighting the need for a rate‐adaptive sensor that responds to mental loads. One such sensor utilizes Closed Loop Stimulation (CLS), which translates right ventricular contractility into patient specific pacing rates. Clinical studies utilizing CLS [Emotional Response (ER) and Emotional Response 2 (ER2) studies] have been performed to confirm CLS provides appropriate heart rate response to acute mental stress. The objective of these studies was to compare heart rates during a mental stress test, with the patient's pacemaker programmed to a CLS pacing mode and an accelerometer pacing mode.