VIP to reduce the percentage of unnecessary right ventricular pacing

Tracing
N° 1
Manufacturer Abbott Device PM Field Pacing Modes
Patient
  • 74-year-old man
  • AccentTM DR  pacemaker (Abbott) for sinus dysfunction
  • 100% right ventricular pacing
  • DDD mode
  • Programming of the VIP algorithm
Graph and trace
  • Atrial pacing and ventricular pacing at the programmed lower rate limit
  • Programming of the VIP algorithm
  • Resumption of intrinsic atrioventricular conduction, ventricular sensing and inhibition of ventricular pacing
Comments
  • There is no specific mode per se to reduce the percentage of unnecessary right ventricular pacing in AbbottTM pacemakers
  • The VIP algorithm corresponds to an AV delay hysteresis
  • The AV delay is prolonged over a limited number of intervals to promote the return of intrinsic conduction
  • At the end of the prolonged AV period, if no ventricular event has occurred, ventricular pacing is delivered
  • There can be no dropped P wave during this search, given that ventricular pacing always occurs at the end of the prolonged AV delay in the absence of ventricular sensing
  • The main advantage of this algorithm is therefore to permanently maintain a 1:1 activation ratio between atria and ventricles
  • On this tracing, activation of the VIP allows reducing the percentage of right ventricular pacing from 100 to 0%
  • In the long term, this should prove beneficial in terms of ventricular remodeling and occurrence of atrial arrhythmia