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Modes of cardiac pacing: Nomenclature and selection

David L Hayes, MD
Section Editor
Mark S Link, MD
Deputy Editor
Brian C Downey, MD, FACC


Once it has been established that bradycardia or a conduction disorder warrants permanent pacing, the most appropriate pacing mode for the patient must be selected. The choice depends upon the specific abnormality that is present, since a wide range of pacemaker functions have been developed to accommodate specific clinical needs (table 1). (See "Permanent cardiac pacing: Overview of devices and indications".)

To facilitate the use and understanding of pacemakers, a standardized classification code has been developed. Most patients can be managed with one of two or three common modes (AAI, VVI, or DDD), with or without rate-responsiveness.

The majority of contemporary pacemakers are versatile and capable of the most commonly used pacing modes and basic functions (ie, mode-switching and rate-responsiveness). Some features, such as rate-drop pacing and managed ventricular pacing, are available in selected devices.

Pacemaker nomenclature and the clinical application of common pacing modes and functions will be reviewed here.


Five position code — A three-letter code describing the basic function of the various pacing systems was first proposed in 1974 by a combined task force from the American Heart Association and the American College of Cardiology and subsequently updated by a committee from the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). The code, which has five positions, is designated the NBG code for pacing nomenclature (table 2) [1].

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Literature review current through: Nov 2017. | This topic last updated: May 05, 2016.
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