Contemporary devices include sophisticated algorithms specifically designed to minimize ventricular pacing, with the intention of limiting the patient's exposure to potentially deleterious effects of right ventricular pacing. The added complexity and adverse effects (some potentially life-threatening) associated with the use of these algorithms are often under-appreciated. The operational features, efficacy, and the potential adverse effects associated with one of these algorithms to minimize ventricular pacing-the Managed Ventricular Pacing™ algorithm-are reviewed to guide the appropriate prescription of this therapy.