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Pisanò ECL, Calvi V, Viscusi M, Rapacciuolo A, Lazzari L, Bontempi L, Pelargonio G, Arena G, Caccavo V, Wang CC, Merkely B, Lin LY, Oh IY, Bertaglia E, Saporito D, Menichelli M, Nicosia A, Carretta DM, Coppolino A, Ching CK, Del Castillo ÁM, Su X, Del Maestro M, Giacopelli D, Gargaro A, Botto GL. Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions. Europace 2024; 26:euae175. [PMID: 38938169 DOI: 10.1093/europace/euae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
AIMS Subclinical atrial fibrillation (AF) is associated with increased risk of progression to clinical AF, stroke, and cardiovascular death. We hypothesized that in pacemaker patients requiring dual-chamber rate-adaptive (DDDR) pacing, closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring would reduce the occurrence of atrial high-rate episodes (AHREs) compared with conventional DDDR pacing. METHODS AND RESULTS Patients with sinus node dysfunctions (SNDs) and an implanted pacemaker or defibrillator were randomly allocated to dual-chamber CLS (n = 612) or accelerometer-based DDDR pacing (n = 598) and followed for 3 years. The primary endpoint was time to the composite endpoint of the first AHRE lasting ≥6 min, stroke, or transient ischaemic attack (TIA). All AHREs were independently adjudicated using intra-cardiac electrograms. The incidence of the primary endpoint was lower in the CLS arm (50.6%) than in the DDDR arm (55.7%), primarily due to the reduction in AHREs lasting between 6 h and 7 days. Unadjusted site-stratified hazard ratio (HR) for CLS vs. DDDR was 0.84 [95% confidence interval (CI), 0.72-0.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71-0.99; P = 0.033). In subgroup analyses of AHRE incidence, the incremental benefit of CLS was greatest in patients without atrioventricular block (HR, 0.77; P = 0.008) and in patients without AF history (HR, 0.73; P = 0.009). The contribution of stroke/TIA to the primary endpoint (1.3%) was low and not statistically different between study arms. CONCLUSION Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.
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Affiliation(s)
- Ennio C L Pisanò
- Cardiology and Intensive Care Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Valeria Calvi
- Cardiology, G. Rodolico-San Marco University Hospital, Catania, Italy
| | - Miguel Viscusi
- Clinical and Interventional Arrhythmology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Ludovico Lazzari
- Clinical and Interventional Arrhythmology, Santa Maria Hospital, Terni, Italy
| | | | - Gemma Pelargonio
- Arrhythmology, Fondazione Policlinico Gemelli IRCCS Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Arena
- Cardiology and Intensive Care Unit, Apuane New Hospital, Massa, Italy
| | - Vincenzo Caccavo
- Cardiology and Intensive Care Unit, Miulli Regional Hospital, Acquaviva delle Fonti, Italy
| | - Chun-Chieh Wang
- Cardiology, Chang Gung Memorial Hospital-Linkou-CGMH, Taipei, Taiwan
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Lian-Yu Lin
- Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Il-Young Oh
- Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | | | | | | | - Aldo Coppolino
- Cardiology and Intensive Care Unit, Elecrophysiology, SS Annunziata Hospital, Savigliano, Cuneo, Italy
| | - Chi Keong Ching
- Cardiology/Cardiovascular Surgery, National Heart Center, Singapore
| | | | - Xi Su
- Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | | | | | - Alessio Gargaro
- Clinical Research Unit, BIOTRONIK Italia, Cologno Monzese, Milan, Italy
| | - Giovanni L Botto
- ASST Rhodense, Rho & Garbagnate Hospitals, Viale Carlo Forlanini, 95, 20024 Garbagnate Milanese, Milan, Italy
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 156] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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3
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Karakayali M, Artac I, Omar T, Rencuzogullari I, Karabag Y, Hamideyin S. Assessment of the efficacy of the electrocardiographic P-wave peak time in predicting atrial high rate episode in patients with cardiac implantable electronic devices. J Electrocardiol 2023; 80:40-44. [PMID: 37182429 DOI: 10.1016/j.jelectrocard.2023.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION & OBJECTIVE The incidence of atrial high-rate episode (AHRE) is high among patients with cardiac implantable electronic devices (CIEDs). In this context, the objective of this study is to evaluate the efficacies of P-wave indices (PWIs) obtained from the surface electrocardiography (ECG) in predicting future AHRE development. MATERIAL & METHOD The study sample consisted of 158 patients with CIEDs. The study group was divided into two subgroups according to the presence of AHRE during device interrogation. PWIs were calculated using the surface ECG. RESULTS There was no significant difference between the groups in the P-wave indices (PWIs), i.e., minimum P-wave duration (PWDmin), maximum P-wave duration (PWDmax) and P-wave dispersion (PWDIS). On the other hand, P-wave peak time in V1 lead (PWTV1) and P-wave peak time in D2 lead (PWPTD2) were significantly higher in the AHRE group than in the non-AHRE group. CONCLUSION The study findings revealed that novel ECG parameters PWPTV1 and PWPTD2 had high prognostic value in predicting patients likely to develop AHRE.
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Affiliation(s)
- Muammer Karakayali
- Kafkas University School of Medicine, Department of Cardiology, Kars, Turkey.
| | - Inanç Artac
- Kafkas University School of Medicine, Department of Cardiology, Kars, Turkey
| | - Timor Omar
- Kafkas University School of Medicine, Department of Cardiology, Kars, Turkey
| | | | - Yavuz Karabag
- Kafkas University School of Medicine, Department of Cardiology, Kars, Turkey
| | - Serif Hamideyin
- Kafkas University School of Medicine, Department of Cardiology, Kars, Turkey
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Mundisugih J, Munawar DA, Mahajan R. The Necessary Perils of Pacemaker Implantation in Young Individuals-Can We Do Better? Heart Lung Circ 2022; 31:913-915. [PMID: 35752455 DOI: 10.1016/j.hlc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Juan Mundisugih
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Dian A Munawar
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rajiv Mahajan
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vandenberk B, Letourneau-Shesaf S, Colbert JD, Sumner G, Kuriachan V. Late Ventricular Pacemaker Lead Perforation After Electrical Cardioversion – A Case Report. HeartRhythm Case Rep 2022; 8:501-504. [PMID: 35860770 PMCID: PMC9289046 DOI: 10.1016/j.hrcr.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bert Vandenberk
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Address reprint requests and correspondence: Dr Bert Vandenberk, Libin Cardiovascular Institute of Alberta, University of Calgary, Foothills Medical Centre, 1403–29 St NW, Calgary T2N 2T9, Alberta, Canada.
| | | | - Jillian D. Colbert
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Glen Sumner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Vikas Kuriachan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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9
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 807] [Impact Index Per Article: 269.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Mond HG. Electrocardiographic interpretation of pacemaker algorithms enabling minimal ventricular pacing. Heart Rhythm 2020; 17:1784-1792. [PMID: 32413512 DOI: 10.1016/j.hrthm.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Harry G Mond
- Department of Cardiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; CardioScan Pty Ltd, Camberwell, Victoria, Australia.
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