Up-righting Dual-Chamber Cardiac Pacing. The Story of Managed Ventricular Pacing

A significant milestone in cardiac pacing occurred approximately two decades ago when the primary operating mode was reimagined to more closely mimic normal top-down cardiac activation. Managed Ventricular Pacing (MVP™) was an unprecedented dual-chamber mode as it preferentially paced the right atrium in the AAI/R mode and simultaneously protected against transient heart block, but only in the instance of a dropped ventricular beats. At the time, dual chamber DDD/R with atrial based timing and programmable atrioventricular (AV) delay was the state of the art. MVP “unlocked” conventional dual-chamber pacing by not consistently requiring a 1:1 atrioventricular relationship as defined by an AV delay during its primary operating mode (i.e. AAI/R+). Described herein is the remarkable story of MVP, conceived before the pivotal and highly supportive Dual-Chamber and VVI Implantable Defibrillator (DAVID) Trial was introduced and rooted in lessons learned from “first-in man” permanent His bundle pacing.