Managed Ventricular Pacing

Question 1

When are conduction checks performed?

Answer 1

30 minutes after implant detection is complete, and then if unsuccessful, every 1, 2, 4, 8 min., etc., up to 16 hrs and then every 16 hrs thereafter

Question 2

How are conduction checks performed?

Answer 2

A single AAI pace is delivered and device looks for a Vs. If no Vs, conduction check fails. No back-up pulse is delivered.

Question 3

What causes the device to switch from AAI(R) to DDD(R)?

Answer 3

When two out of 4 cycles occur with no Vs.

Question 4

What happens if the device is in AAI(R) mode and conduction is lost?

Answer 4

A back-up pace is delivered 80 ms after the next scheduled atrial pace.

Question 5

In what patients is MVP not recommended?

Answer 5

CHB, 1st degree heart block, patients with pause dependent VT with no ICD back-up, chronotropically competent patients with rate-dependent AV block

Question 6

What are the undesirable effects of pacing?

Answer 6

Ventricular dyssynchrony, increase in LA diameter, mitral regurgitation, decrease in LV function, increase in HF hospitalization, increase in AF

Question 7

What ways other than MVP can you promote intrinsic conduction?

Answer 7

Use a non-tracking mode, long AV delays, or a search AV plus feature.