Patent ID: 8583232

Claim:
A method of operating an implanted rate adaptive cardiac rhythm management system in a patient, the method comprising: acquiring a pressure signal representative of coronary venous pressure (CVP) from a pressure sensor implanted within the lower apical two thirds of a coronary vein of the patient and generating a CVP waveform therefrom; applying a pacing stimulus to the patient's heart, the pacing stimulus defined by a set of pacing parameters including a pacing rate; acquiring a signal representative of the patient's metabolic demand from at least one implanted sensor; monitoring a CVP index derived from the CVP waveform while increasing the pacing rate in response to an increase in the patient's metabolic demand, wherein the CVP index is based on coronary venous dp/dt (CV-dp/dt) of the CVP waveform; detecting a reduction in the patient's hemodymanic performance based on the CVP index resulting from increasing the pacing rate; and establishing a maximum rate setting based on the pacing rate corresponding to the reduction in the patient's hemodynamic performance, wherein the maximum rate setting delimits further metabolic demand-induced pacing rate increases.