Key result
DDD reprogramming with 250-ms AV interval and ventricular intrinsic preference resolves VA conduction and palpitations.
Why the study?
Does reprogramming to DDD mode with a ventricular intrinsic preference algorithm prevent 2:1 AV rhythm and palpitations caused by a long AV delay in DDI mode?
Case Report (n=1)
Does reprogramming to DDD mode with a ventricular intrinsic preference algorithm prevent 2:1 AV rhythm and palpitations caused by a long AV delay in DDI mode?
Reprogramming a pacemaker to DDD mode with a ventricular intrinsic preference algorithm can effectively resolve pacemaker-mediated 2:1 AV rhythm and palpitations caused by long AV delays in DDI mode.
Answers are grounded in this paper and cite their sources.
DDI with long AV delay may provoke VA conduction-related symptoms; hypothesis-generating for optimal programming in intermittent AV block.
A 91-year-old woman received a dual-chamber pacemaker for sick sinus syndrome and intermittently abnormal atrioventricular (AV) conduction. The pacemaker was set in DDI mode with a 350-ms AV delay to preserve intrinsic ventricular activity. She complained of palpitation during AV sequential pacing. The electrocardiogram showed a 2:1 AV rhythm from 1:1 ventriculoatrial (VA) conduction during ventricular pacing in DDI mode with a long AV interval. After reprogramming of the pacemaker in DDD mode with a 250-ms AV interval and additional 100-ms prolongation of the AV interval by the ventricular intrinsic preference function, VA conduction disappeared and the patient's symptom were alleviated without increasing unnecessary right ventricular pacing.
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Minamiguchi et al. (2011) conducted a case report in Sick sinus syndrome and intermittently abnormal atrioventricular (AV) conduction (n=1). Reprogramming pacemaker to DDD mode with a 250-ms AV interval and ventricular intrinsic preference function vs. DDI mode with a 350-ms AV delay was evaluated on Disappearance of VA conduction and alleviation of symptoms. Reprogramming a dual-chamber pacemaker to DDD mode with a 250-ms AV interval and ventricular intrinsic preference eliminated VA conduction and alleviated palpitations.
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