This DDDRP pacemaker is safe, has accurate AT/AF detection, and provides ATP with 54% efficacy as defined by the device. The atrial prevention and termination therapies combined did not reduce AT/AF burden or frequency in this patient population.

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In 1990, Hochleitner reported improvement in cardiac function in 16 patients with idiopathic dilated cardiomyopathy treated with dual-chamber pacemakers programmed with atrioventricular (AV) delays of 100 msec. 1 This observation initiated a number of small, single-site studies that evaluated the use of dual-chamber pacemakers in patients with left ventricular dysfunction. 2-5 Particular attention was paid to the relationship of different paced AV delays on cardiac function. In general, changes in the AV delay did not significantly alter mean cardiac output values assessed by invasive hemodynamic monitoring or by Doppler echo studies. Selected patients appeared to improve substantially, although the interpretation of results of a subset of patients from these already small studies could result in erroneous conclusions. For example, one study reported that patients with prolongation of the PR interval had a 38% increase in cardiac output with optimal AV delay programming, 2 a finding not substantiated in another trial. 3 The evidence that dual-chamber pacing improved left ventricular function, even with optimally programmed AV delays, was not compelling.It is perhaps because of this background that the determination of an optimal AV delay in cardiac resynchronization therapy has been met with such mixed results in the pacemaker community. Some physicians rarely perform "AV optimization." Others favor a strategy of programming relatively short AV delays (<140 msec) to ensure a high rate of biventricular pacing. If clinical improvement is less than expected, optimization of the paced AV delay is performed. Still other physicians perform echo studies after resynchronization therapy on a more routine basis and have noted that 40% of patients undergoing optimal AV delay assessment have final programmed AV intervals of >140 msec suggesting that "out-of-the-box" settings are undesirable for a large number of patients. 6 In the only randomized prospective trial in this area, patients receiving a biventricular device were randomized to either an echo-optimized AV delay or an empiric AV delay of 120 msec. Those who had optimized AV delays had modest improvement in quality of life scores, New York Heart Association class, and left ventricular ejection fractions after three months of follow-up. 7 The optimal AV delay varied widely from patient to patient. However, the mean paced AV delay in the echo-optimized group was 119 msec, practically identical to the comparator group with an AV delay of 120 msec. Like the experience with dual-chamber pacing in heart failure, it appears that an optimal paced AV delay results in modest improvement in cardiac function in certain patients.Unfortunately, "AV optimization" is a cumbersome procedure requiring the coordination of several services. It requires online adjustment of pacing parameters while echo measurements of diastolic filling, mitral regurgitation, and cardiac output are assessed. Consequently, a variety of methods have been derived to predict the optimal paced AV delay based o...

A 69-year-old severely obese diabetic woman developed nausea, vomiting and diarrhoea which caused multiple metabolic alterations leading to hypotension and bradycardia due to slow atrioventricular junctional rhythm. Transcutaneous pacing (TCP) was initiated and maintained until the underlying heart rate and blood pressure normalised. TCP gel pads were kept in place prophylactically after pacing was terminated. Gel pads remained attached to the anterior thorax and back for a total of 36 hours. During this time the patient developed third-degree burns at the side of gel pad attachment. With appropriate wound care and after a long hospitalisation, the patient was discharged in stable condition. This case demonstrates that prolonged use of TCP gel pads without frequent replacement may lead to third-degree burns. It also suggest that prophylactic use of TCP gel pads should be avoided.