Pacemaker troubleshooting: When MVP is not the most valuable parameter

Mansour, Fadi; Talajic, Mario; Thibault, Bernard; Khairy, Paul

doi:10.1016/j.hrthm.2005.12.028

Cited by 23 publications

(21 citation statements)

References 11 publications

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“…In other 16 test cases, AVH significantly reduces VP% compared to standard DDD (p<1e-6 for all except for test case 5 where p<0.05). Also note that NM conduction does not guarantee VS (e.g., test cases 15,16,18,20), mainly due to presence of retrograde atrial activations (data now shown).…”

Section: Resultsmentioning

confidence: 85%

“…While it is true that too frequent RVP is associated with adverse effects in cardiac function [2]- [4], unconditional elimination of RVP could be just as detrimental [17], due to potential AV decoupling/uncoupling [18], increased risk of retrograde conduction and pacemaker mediated tachycardia [19], compromised ventricular support due to nonphysiologic AV intervals [20,21], and so on. Therefore, design of RVP suppression algorithm must strike a balance between promoting intrinsic AV conduction and maintaining the AV synchrony.…”

Section: Discussionmentioning

confidence: 99%

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Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Lian

Garner

Krätschmer

et al. 2009

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Long term right ventricular apical pacing has been known to have adverse effects in cardiac function. The AV hysteresis (AVH) is a feature existing in many dual-chamber cardiac pacemakers that aims to minimize the right ventricular pacing, but its clinical efficacy remains inconclusive due to conflicting evidence from different studies. We have recently developed a novel integrated dual-chamber heart and pacer (IDHP) model, which can simulate various interactions between intrinsic heart activity and extrinsic cardiac pacing. In this study, we use the IDHP model to simulate various atrio-ventricular (AV) conduction pathologies, and to investigate the effects of an AVH algorithm on reducing right ventricular pacing. Our results show that the efficacy of AVH is dependent on the underlying cardiac conditions. While it can preserve intrinsic conduction during minor or moderate first degree AV block, its efficacy is reduced at higher degree AV block conditions. This pilot study further supports using the IDHP model to design and evaluate more advanced pacemaker algorithms for therapeutic interventions.

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Section: Resultsmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Lian

Garner

Krätschmer

et al. 2009

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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show abstract

“…Such haemodynamic trade-off may compromise the advantage of MVP, especially in patients with unusually long intrinsic AV conduction. 18 Conversely, Search AV+ is able to establish an upper limit on the magnitude of AV conduction time and could prevent excessive long intrinsic AV conduction. The present study has not examined the clinical impact derived from the difference in %VPs between the two algorithms.…”

Section: Discussionmentioning

confidence: 99%

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study

et al. 2009

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AimsManaged ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms.Methods and resultsSymptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled. The %VPs of the patients during two periods were compared: 1 month operation of either one of the two algorithms for each period. All patients were categorized into subgroups according to the atrioventricular block (AVB) status at baseline: no AVB (nAVB), first-degree AVB (1AVB), second-degree AVB (2AVB), episodic third-degree AVB (e3AVB), and persistent third-degree AVB (p3AVB). Data were available from 127 patients for the analysis. For all patient subgroups, except for p3AVB category, the median %VPs were lower during the MVP operation than those during the Search AV+ (nAVB: 0.2 vs. 0.8%, P < 0.0001; 1AVB: 2.3 vs. 27.4%, P = 0.001; 2AVB: 16.4% vs. 91.9%, P = 0.0052; e3AVB: 37.7% vs. 92.7%, P = 0.0003).ConclusionManaged ventricular pacing algorithm, when compared with Search AV+, offers further %VP reduction in patients implanted with a dual-chamber pacemaker, except for patients diagnosed with persistent loss of atrioventricular conduction.

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“…This has prompted the search for novel pacing strategies that reduce unnecessary ventricular pacing, and thereby reducing the cumulative percentage of ventricular pacing (Kaltman et al, 2008;Sweeney et al, 2004). Managed ventricular pacing (MVP) and AAISafeR modes are new pacing algorithms designed for reducing cumulative percentage of ventricular pacing, with established benefits in the adult population (Mansour et al, 2006;van Mechelen & Schoonderwoerd, 2006). This pacing strategy requires the implantation of a dual chamber device, programmed in DDD or DDDR mode.…”

Section: Strategies To Minimize Ventricular Pacingmentioning

confidence: 99%

“…It primarily paces the atrium and monitors the ventricle for loss of AV conduction. When no ventricular beats are sensed between two consecutive atrial sensed or paced beats, MVP automatically mode switches to DDD or DDDR backup pacing (Kaltman et al, 2008;Mansour et al, 2006). Adverse effects have been described in the adult population, including tachyarrhythmias, ventricular fibrillation and failure of mode switch to ventricular backup pacing (Mansour et al, 2006;van Mechelen & Schoonderwoerd, 2006).…”

Section: Strategies To Minimize Ventricular Pacingmentioning

confidence: 99%

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

Cate¹,

Sreeram²

2011

Modern Pacemakers - Present and Future

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Pacemaker troubleshooting: When MVP is not the most valuable parameter

Cited by 23 publications

References 11 publications

Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

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