Key result
Five noninvasive methods accurately measure ventriculoatrial conduction in DDD or VDD pacemakers to set PVARP.
Provides a description of five noninvasive methods to measure retrograde conduction times in pacemaker patients to optimize PVARP settings and prevent pacemaker-mediated tachycardia.
May enable noninvasive PVARP optimization in DDD/VDD pacemakers; leaves open prospective validation of PMT reduction.
Retrograde, or ventriculoatrial conduction (VAC) has been measured in 67% of pacemaker patients with SSS and 25% of patients with 3 degrees block. DDD pacers use the postventricular atrial refractory period (PVARP) to prevent sensing VAC. If the PVARP is too short, a pacer-mediated tachycardia (PMT) could occur. If too long, rapid atrial rates may not be sensed. To accurately set the PVARP, VAC must be measured. Five noninvasive methods are described: (1) Surface ECG during VVI pacing; (2) Atrial intracardiac electrograms during VVI pacing; (3) Initiating a PMT with long pacemaker AV interval; (4) Initiating a PMT at the maximum tracking rate; (5) DDI mode with electronic calipers. The description of these methods is intended to enable a physician to detect and measure VAC in patients with any manufacturer's DDD or VDD pacemaker.
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MARCO et al. (1988) conducted a review in Pacemaker patients with sick sinus syndrome or third-degree heart block. Noninvasive measurement of retrograde conduction times was evaluated. Five noninvasive methods can be used by physicians to detect and measure ventriculoatrial conduction in patients with any manufacturer's DDD or VDD pacemaker to accurately set the PVARP.
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