Looked Like Pacemaker Malfunction But Not

Vignette: A patient s/p pacemaker implantation was being monitored in the unit. The primary RN was notified of this event? Is this a pacemaker malfunction?

Image 1 - ECG case

Image 2 - Image case marked

Pacemakers nowadays are getting smarter. They can think and know what to do. In red box # 1 above, the machine is in atrial-based pacing mode (with prolonged AV conduction). In box # 2, When an AV blocked is detected, it delivered back-up ventricular pacing, In box # 3, the device switches to DDD mode.

This machine is in MVP mode or Managed Ventricular Pacing mode. This mode is used to reduced unnecessary right ventricular pacing which may be associated with the risk of atrial fibrillation, left ventricular dysfunction and congestive heart failure, especially in patients with intact AV conduction or intermittent AV conduction.

Specifically, MVP provides the following functions:

● AAI(R) mode pacing when AV conduction is intact

● the ability to switch to DDD(R) pacing during AV block

● periodic conduction checks while operating in DDD(R) mode, with the ability to switch back to AAI(R) mode when AV conduction resumes

● backup ventricular support for transient loss of AV conduction 

So, this patient was implanted with Medtronic Advisa pacemaker with MVP mode (AAI - DDD). The machine is working normally.

Reference: http://manuals.medtronic.com/wcm/groups/mdtcom_sg/@emanuals/@era/@crdm/documents/documents/contrib_235431.pdf

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