Inappropriate spikes on telemetry? PART 3

Same patiënt as previous cases, a 81-year old patient with a sick sinus syndrome and a dual chamber Medtronic pacemaker, admitted due to chest pains.

Coronary agiography showed signficiant lesions in the LAD for which FFR measurements were negative.

Last night he showed the following telemetry strip:

What are your ideas?

Physician advice: 
Trace category: 

I suspect that this is an algorithm for minimizing right ventricular pacing (MVP). At first there is a pause after the blocked atrial extrasystole. Then there is a stimulation of the atria and a safety stimulation of the ventricles with short AVD. In the event of a missing VS, the device gives a backup ventricular stimulation following the next AS or AP, such that two consecutive missing VS events are not permitted, however single dropped beats, e.g. during Mobitz type 1 (Wenckebach) second degree AV block are permitted. 

Exactly Lubimceya! Thanks for posting!

MVP stands for Managed Ventricular Pacing.

It is fully explained here: