Reduction of ventricular pacing percentage

N° 34
Same patient as previous tracing; device programmed in DDD mode 70 bpm followed by managed ventricular pacing (MVP) mode;
Reduction of ventricular pacing percentage
Reduction of ventricular pacing percentage

There is extensive literature demonstrating the deleterious effect of prolonged right ventricular pacing. Similarly, any reduction in unnecessary ventricular pacing saves battery life thereby maximizing pacemaker life. Different modes have been proposed by manufacturers (MVP for Medtronic pacemakers) to reduce the percentage of ventricular pacing without compromising the safety of the patient during the onset of an atrioventricular conduction disorder. The preferred indication of this type of mode is therefore the presence of a sinus node dysfunction with preserved atrioventricular conduction or altered in a paroxysmal manner.

The MVP mode, AAI <=> DDD, enables pacing in ADI mode while monitoring atrioventricular conduction. The operation of this algorithm is relatively simple with a single criterion for switching to the DDD mode. During operation in ADI mode, the settings associated with single chamber atrial pacing are applicable. Ventricular sensing is active.

On this tracing, the major advantage of this algorithm appears obvious. Indeed, compared to pacing in DDD mode, the programming of this mode considerably reduces the percentage of ventricular pacing. On the long term, this should be associated with a benefit in terms of ventricular remodeling and occurrence of atrial arrhythmia. Analysis of the percentage of ventricular pacing is therefore an important element of follow-up in a patient with sinus node dysfunction, insofar as to minimize the occurrence of any unnecessary ventricular pacing.

Each manufacturer has developed a specific mode of pacing to decrease the percentage of unnecessary right ventricular pacing in non-dependent patients. The particular operational modalities of each manufacturer must be known by the physician in order to be able to interpret the specificities of each tracing.