UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Modes of cardiac pacing: Nomenclature and selection

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

INTRODUCTION

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.

NOMENCLATURE

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].

                                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu May 05 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Bernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol 2002; 25:260.
  2. Sweeney MO, Prinzen FW. A new paradigm for physiologic ventricular pacing. J Am Coll Cardiol 2006; 47:282.
  3. Sweeney MO, Bank AJ, Nsah E, et al. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med 2007; 357:1000.
  4. Sweeney MO, Ellenbogen KA, Casavant D, et al. Multicenter, prospective, randomized safety and efficacy study of a new atrial-based managed ventricular pacing mode (MVP) in dual chamber ICDs. J Cardiovasc Electrophysiol 2005; 16:811.
  5. Olshansky B, Day JD, Moore S, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) study. Circulation 2007; 115:9.
  6. Ricci RP, Botto GL, Bénézet JM, et al. Association between ventricular pacing and persistent atrial fibrillation in patients indicated to elective pacemaker replacement: Results of the Prefer for Elective Replacement MVP (PreFER MVP) randomized study. Heart Rhythm 2015; 12:2239.
  7. Stockburger M, Boveda S, Moreno J, et al. Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population. Eur Heart J 2015; 36:151.
  8. Curtis AB, Worley SJ, Adamson PB, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013; 368:1585.
  9. Curtis AB, Worley SJ, Chung ES, et al. Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing: The BLOCK HF Study. J Am Coll Cardiol 2016; 67:2148.
  10. Hayes DL, Furman S. Stability of AV conduction in sick sinus node syndrome patients with implanted atrial pacemakers. Am Heart J 1984; 107:644.
  11. Antonioli, G, Ansani, L, Barbieri, D, et al. Single-Lead VDD Pacing. In: New Perspectives in Cardiac Pacing, 3, Barold, S, Mugica, J (Eds), Futura Publishing, Mount Kisco 1993.
  12. Rey JL, Tribouilloy C, Elghelbazouri F, Otmani A. Single-lead VDD pacing: long-term experience with four different systems. Am Heart J 1998; 135:1036.
  13. Huang M, Krahn AD, Yee R, et al. Optimal pacing for symptomatic AV block: a comparison of VDD and DDD pacing. Pacing Clin Electrophysiol 2004; 27:19.
  14. Wiegand UK, Bode F, Schneider R, et al. Development of sinus node disease in patients with AV block: implications for single lead VDD pacing. Heart 1999; 81:580.
  15. Morsi A, Lau C, Nishimura S, Goldman BS. The development of sinoatrial dysfunction in pacemaker patients with isolated atrioventricular block. Pacing Clin Electrophysiol 1998; 21:1430.
  16. Lamas GA, Ellenbogen KA. Evidence base for pacemaker mode selection: from physiology to randomized trials. Circulation 2004; 109:443.
  17. Healey JS, Toff WD, Lamas GA, et al. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation 2006; 114:11.
  18. Stewart WJ, Dicola VC, Harthorne JW, et al. Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers. Effects of left ventricular function and retrograde ventriculoatrial conduction. Am J Cardiol 1984; 54:308.
  19. Rediker DE, Eagle KA, Homma S, et al. Clinical and hemodynamic comparison of VVI versus DDD pacing in patients with DDD pacemakers. Am J Cardiol 1988; 61:323.
  20. Boon NA, Frew AJ, Johnston JA, Cobbe SM. A comparison of symptoms and intra-arterial ambulatory blood pressure during long term dual chamber atrioventricular synchronous (DDD) and ventricular demand (VVI) pacing. Br Heart J 1987; 58:34.
  21. Takeuchi M, Nohtomi Y, Kuroiwa A. Effect of ventricular pacing on coronary blood flow in patients with normal coronary arteries. Pacing Clin Electrophysiol 1997; 20:2463.
  22. Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation 1998; 97:987.
  23. Ausubel K, Furman S. The pacemaker syndrome. Ann Intern Med 1985; 103:420.
  24. Lamas GA, Orav EJ, Stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators. N Engl J Med 1998; 338:1097.
  25. Andersen HR, Thuesen L, Bagger JP, et al. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994; 344:1523.
  26. Lamas GA, Lee KL, Sweeney MO, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002; 346:1854.
  27. Connolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med 2000; 342:1385.
  28. Toff WD, Camm AJ, Skehan JD, United Kingdom Pacing and Cardiovascular Events Trial Investigators. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med 2005; 353:145.
  29. Kerr CR, Connolly SJ, Abdollah H, et al. Canadian Trial of Physiological Pacing: Effects of physiological pacing during long-term follow-up. Circulation 2004; 109:357.
  30. Andersen HR, Nielsen JC, Thomsen PE, et al. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997; 350:1210.
  31. Hellkamp AS, Lee KL, Sweeney MO, et al. Treatment crossovers did not affect randomized treatment comparisons in the Mode Selection Trial (MOST). J Am Coll Cardiol 2006; 47:2260.
  32. Skanes AC, Krahn AD, Yee R, et al. Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing. CTOPP Investigators. J Am Coll Cardiol 2001; 38:167.
  33. Tang AS, Roberts RS, Kerr C, et al. Relationship between pacemaker dependency and the effect of pacing mode on cardiovascular outcomes. Circulation 2001; 103:3081.
  34. Ellenbogen KA, Stambler BS, Orav EJ, et al. Clinical characteristics of patients intolerant to VVIR pacing. Am J Cardiol 2000; 86:59.
  35. Jahangir A, Shen WK, Neubauer SA, et al. Relation between mode of pacing and long-term survival in the very elderly. J Am Coll Cardiol 1999; 33:1208.
  36. Link MS, Hellkamp AS, Estes NA 3rd, et al. High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST). J Am Coll Cardiol 2004; 43:2066.
  37. Sulke N, Chambers J, Dritsas A, Sowton E. A randomized double-blind crossover comparison of four rate-responsive pacing modes. J Am Coll Cardiol 1991; 17:696.
  38. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.
  39. Kusumoto FM, Goldschlager N. Cardiac pacing. N Engl J Med 1996; 334:89.