Modes of cardiac pacing: Nomenclature and selection
- David L Hayes, MD
David L Hayes, MD
- Professor of Medicine
- Mayo Medical School
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) .
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- Five position code
- - Position I
- - Position II
- - Position III
- - Position IV
- - Position V
- - Mode switching
- - Rate responsiveness
- - Rate drop
- - Modes to minimize ventricular pacing
- - Biventricular pacing
- PACING MODES
- Single chamber pacing
- - VVI or VVIR pacing
- - AAI or AAIR pacing
- Dual chamber pacing
- - DDD or DDDR pacing
- - DDI or DDIR pacing
- - Less common modes
- VDD pacing
- DVI pacing
- Asynchronous pacing
- - AOO, VOO, or DOO mode
- PHYSIOLOGIC PACING
- Potential advantages
- - Effect on morbidity and mortality
- Pacemaker syndrome
- Patient preference
- MODE SELECTION ALGORITHMS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Single or dual chamber pacemakers
- Additional features