Right Ventrical Pacing in AAI (R) mode

Right ventricular pacing

by TAC - 2022-02-14 12:22:40

 The only thing I can tell you is that your PM is designed to pace mostly your right atria. The reason why  your PM was implanted was for a sick sinus (failure), but with a normal A/V conduction. This mode saves unnecessary pacing of the right ventricle. However, even though you have a normal A / V conduction. For safety, in case your right ventricle might need an occasional pacing, you have the MVP (Managed Ventricular Pacing) on. So, the report says that your atria is doing most of the pacing 90.4%. However, there was an instance 0.1% (very minimal) in which some right ventricle pacing was necessary. 

Managed Ventricular pacing

by Gemita - 2022-02-14 13:55:59

Hello Ratcheva

TAC has already given good advice.  I have a Medtronic pacemaker set in AAIR Mode.  Like you I am also atrial paced (almost 99% last check), with just a limited percentage of ventricular pacing of around 1 %.  I see you are even less at 0.1% which I wouldn’t be worried about at all.  My Managed Ventricular Pacing (MVP) feature is turned on I believe to prevent unnecessary ventricular pacing.

The definition of MVP:-

MVP modes promote intrinsic (natural) conduction by reducing unnecessary right ventricular pacing. These modes provide atrial-based pacing with ventricular backup.   If AV conduction is lost, the device is designed to switch to DDDR or DDD mode. Periodic conduction checks are performed, and if AV conduction resumes, the device switches back to AAIR/AAI = Atrial demand pacing (with rate response) or AAI alone.

So yes it will be normal to pace in the right ventricle sometimes even though your main mode of pacing is AAIR because when AV conduction is lost, AAIR or AAI will automatically switch to DDDR or DDD mode. 

I would encourage you to ask for details of your settings, so that you can find out what is set up in your pacemaker.  I would also discuss your condition/pacemaker settings with your doctors, so that they will know you want to learn.  Good luck

Thanks

by ratcheva - 2022-02-15 05:39:22

Thanks to TAC and Gemita for their explanations!

One detail is that my doctor told me that PM does nor change the mode from AAI (R) to DDD (R) automatically. It always stays in AAI (R) mode. I will post if I get an explanation from the doctor.

You are welcome

by Gemita - 2022-02-15 07:20:08

Yes you need an explanation in view of what you have been told.  Your data clearly states that you have MVP turned "on", presumably for a reason?  I also note that you have a dual chamber pacemaker.  Unless this information is incorrect, or your right ventricular lead has been switched off and your dual chamber pacemaker has been programmed to only function in AAI mode (or something like this), pacing in the right ventricle is always possible, even for the shortest of periods.  There are other possibilities too for automatic mode switching to occur but only your doctors can tell you what is set up in your pacemaker and answer any questions about your health condition necessitating a pacemaker.  

Please let us know what you find out, but please remember 0.1% ventricular pacing is not, in my opinion, a significant figure or something to really worry about

Azure S DR W3DR01 Pacing

by ratcheva - 2022-03-19 12:08:11

Results of my last visit:

My EP made a correction to his original statement that PM works only in AAIR mode and confirmed what Gemita explained in her previous message: When MVP is “on” PM automatically switches from AAIR to DDDR mode if AV conduction is lost.

Since the implantation of the PM in January 2022 I did not get any AF episodes (usually I used to have 1 -2 per month). It looks like eliminating the bradycardia and starting Bisoprolol 2.5 mg daily is helping for the moment. So we decided not to increase the PM base rate and to stay at 60 bpm for the moment.

Soon or later I will get AF, I asked what PM will do in such a case. I could not get a clear answer to this question.

On page 6 of the manual for my Azure S DR MRI SureScan™ W3DR01 PM is written that an Atrial Preference Pacing (APP) mode is available, which means that the system provides an overdrive pacing technique designed to counteract potential atrial tachyarrhythmia initiating mechanisms. APP maintains a consistent activation sequence by providing continuous pacing that is slightly higher than the intrinsic rate. Please see the link:

https://manuals.medtronic.com/content/dam/emanuals/crdm/M977343A001B_view.pdf 

Anybody having experience with what Medtronic  Azure S  W3DR01 PM will do when the patient is in AF?