The Prescription of Minimal Ventricular Pacing

Lim, Hoong Sern

doi:10.1111/j.1540-8159.2012.03490.x

Cited by 8 publications

(6 citation statements)

References 46 publications

(67 reference statements)

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“…In the presented ECG tracing (Figure 2), the shortening of AV interval might resemble ventricular safety pacing (fourth and seventh complex). The algorithm promoting native AV conduction should also be taken into account as another differential (Lim, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…After the next undersensed QRS complex (U2) and sending backup ventricular stimulus, the pacemaker switched the mode to DDD. Details in the text programming of a persistently long AV interval and/or the use of a pacemaker algorithm to "dynamically" extend the AV interval, allows more time for intrinsic conduction and obviates the need for RV pacing (Lim, 2012). The ventricular safety pacing spike occurs after 100-110 ms following the atrial pacing spike.…”

Section: Discussionmentioning

confidence: 99%

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Switch between AAI and DDD mode pacing—What is the mechanism?

Ząbek

Małecka

Nowosielska-Ząbek

et al. 2019

Noninvasive Electrocardiol

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The electrocardiogram (ECG) interpretation in patients with implantable pacemaker is often a perplexing problem. The difficulty in the device evaluation increases in the presence of novel timing cycles and additional functions. Authors describe a special function frequently encountered in Medtronic dual-chamber pacemakers and implantable cardioverter-defibrillator devices called managed ventricular pacing (MVP) and demonstrate its performance in the patient with undersensing episodes in ventricular channel. Intermittent ventricular undersensing in the device with MVP feature turned on caused repetitive mode switches between AAI and DDD mode. This report shows unexceptional occurrence of tricky ECG findings in patient with Medtronic dual-chamber device.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Switch between AAI and DDD mode pacing—What is the mechanism?

Ząbek

Małecka

Nowosielska-Ząbek

et al. 2019

Noninvasive Electrocardiol

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“…In some patients, symptoms resembling pacemaker syndrome are provoked by the unfavourable prolongation of the AV electromechanical sequence. 16 , 17 Hence, VP prevention in the case of marked first-degree AVB may unintentionally impair overall haemodynamics despite preserving ventricular synchronicity. In view of this possible shortcoming, the more complexly adapting SafeR mode may be regarded as particularly appropriate to achieve low VP percentages in patients with AVB without provoking disadvantageously decoupled AV activation patterns.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficiency of ventricular pacing prevention with an AAI-DDD changeover mode in patients with sinus node disease or atrioventricular block: impact on battery longevity—a sub-study of the ANSWER trial

et al. 2015

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AimsThis ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and replacement rate.Methods and resultsPatients implanted for atrioventricular block (AVB, n = 310) or sinus node dysfunction (SND, n = 336) were randomly assigned to SafeR (n = 314) or DDD (n = 318) and followed for 36 months. Safety, median VP, estimated device longevity (mean difference, 95% confidence interval [CI]), and anticipated replacement rates were analysed by pacing mode and implant indication. No difference in mortality, syncope, or mode intolerance was observed between randomization groups regardless of the indication. Ventricular pacing on SafeR vs. DDD was 11.5 vs. 93.6% in the overall population (P < 0.001), 89.2 vs. 83.8% in permanent AVB (P = 0.944), 53.5 vs. 98.2% in intermittent AVB (P < 0.001), and 2.2 vs. 84.7% in SND (P < 0.001). Anticipated median device longevity increased on SafeR by 14 [Q1 10; Q3 17] months [10; 17] (P < 0.001) in the overall population, 9 months [−5; 22] (P = 0.193) in permanent AVB, 14 months [8; 19] (P < 0.001) in intermittent AVB, and 14 months [9; 19] (P < 0.001) in SND. In intermittent AVB and SND, prolonged estimated battery longevity translated into the prevention of one anticipated replacement in at least 23% of patients.ConclusionSafeR was effective in reducing VP in intermittent AVB and in SND. No effect was observed in permanent AVB. No safety issue was observed. Ventricular pacing reduction by SafeR translated into relevant estimated prolongation of device longevity and anticipated reduction of required replacements.

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“…There are, however, reservations around programming DDD pacemakers with long AV intervals, since deleterious consequences such as endless loop (or pacemaker‐mediated) tachycardias and timing cycle conflicts that limit the detection of atrial tachyarrhythmias have been reported. In light of recently expressed concerns about possible proarrhythmic effects of algorithms designed to minimize ventricular pacing, it is reassuring to note that no ventricular tachyarrhythmic events were associated with the SafeR mode in the CAN‐SAVE R trial.…”

Section: Discussionmentioning

confidence: 99%

Very Low Ventricular Pacing Rates Can Be Achieved Safely in a Heterogeneous Pacemaker Population and Provide Clinical Benefits: The CANadian Multi‐Centre Randomised Study‐Spontaneous AtrioVEntricular Conduction pReservation (CAN‐SAVE R) Trial

Thibault

Ducharme

Baranchuk

et al. 2015

JAHA

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BackgroundIt is well recognized that right ventricular apical pacing can have deleterious effects on ventricular function. We performed a head-to-head comparison of the SafeR pacing algorithm versus DDD pacing with a long atrioventricular delay in a heterogeneous population of patients with dual-chamber pacemakers.Methods and ResultsIn a multicenter prospective double-blinded randomized trial conducted at 10 centers in Canada, 373 patients, age 71±11 years, with indications for dual chamber DC pacemakers were randomized 1:1 to SafeR or DDD pacing with a long atrioventricular delay (250 ms). The primary objective was twofold: (1) reduction in the proportion of ventricular paced beats at 1 year; and (2) impact on atrial fibrillation burden at 3 years, defined as the ratio between cumulative duration of mode-switches divided by follow-up time. Statistical significance of both co-primary end points was required for the trial to be considered positive. At 1 year of follow-up, the median proportion of ventricular-paced beats was 4.0% with DDD versus 0% with SafeR (P<0.001). At 3 years of follow-up, the atrial fibrillation burden was not significantly reduced with SafeR versus DDD (median 0.00%, interquartile range [0.00% to 0.23%] versus median 0.01%, interquartile range [0.00% to 0.44%], respectively, P=0.178]), despite a persistent reduction in the median proportion of ventricular-paced beats (10% with DDD compared to 0% with SafeR).ConclusionsA ventricular-paced rate <1% was safely achieved with SafeR in a population with a wide spectrum of indications for dual-chamber pacing. However, the lower percentage of ventricular pacing did not translate into a significant reduction in atrial fibrillation burden.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/ Unique identifier: NCT01219621.

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The Prescription of Minimal Ventricular Pacing

Cited by 8 publications

References 46 publications

Switch between AAI and DDD mode pacing—What is the mechanism?

Switch between AAI and DDD mode pacing—What is the mechanism?

Safety and efficiency of ventricular pacing prevention with an AAI-DDD changeover mode in patients with sinus node disease or atrioventricular block: impact on battery longevity—a sub-study of the ANSWER trial

Very Low Ventricular Pacing Rates Can Be Achieved Safely in a Heterogeneous Pacemaker Population and Provide Clinical Benefits: The CANadian Multi‐Centre Randomised Study‐Spontaneous AtrioVEntricular Conduction pReservation (CAN‐SAVE R) Trial

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