Cardiac pacing from the apex of the right ventricle has been shown to result in left
ventricular dysfunction, atrial fibrillation, and increased mortality. To counter
these effects, one of the strategies developed is avoidance of ventricular pacing
when not necessary, using programmable algorithms to minimize ventricular pacing.
Seven algorithms are available from 5 manufacturers. Four of the manufacturers have
mode conversion algorithms that pace AAI(R) but, in the presence of failed atrioventricular
(AV) conduction, demonstrate algorithm-offset and convert to DDD(R) with ventricular
pacing. Three manufacturers do not have mode conversion but rather AV extension to
encourage AV conduction. Each of these algorithms has a unique design and, when ventricular
pacing is present, will regularly schedule conduction testing to encourage AV conduction
and hence algorithm-onset. All of these algorithms seem to violate the rule of AV
conduction by allowing the AV delay for sensed ventricular events to be longer than
for ventricular paced events. The result is frequently bizarre electrocardiographic
(ECG) appearances that often are unique to the company’s algorithm but also suggest
pacemaker malfunction. This review highlights and illustrates the features of these
algorithms as they appear on ECG, and discusses other situations that result in unintended
ventricular pacing.
Keywords
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Article info
Publication history
Published online: May 12, 2020
Footnotes
Dr Mond is Medical Director of CardioScan Pty Ltd.
Funding Sources: The author has no funding sources to disclose.
Disclosures: The author has no conflicts of interest to disclose.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Heart Rhythm Society. All rights reserved.
