Optimal Pacing in the Brady-Tachy Syndrome

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The response of antibradycardia pacemakers to rapid atrial rates had become important bcause dualchamber pacemakers are now recommended for patients with altemating bradycardia and tachycardia. In patients with paroxysmal supraventricular tachyarrhythmlas. (SVT) the DDI and DDIR (non-atrial tracking modes are useful in the presence of atrial chronotropic incompetence. The DDI and DDIR modes should nor be used in patients with atrioventricukar (AV) block, paroxysmal SVT, and normal sinus node function, because ventricular, pacing can cause AV dissociation with unfavorable hemodynamic consequences. whenever the sinus rate is faster than the programmed lower rate of the pacemaker. Automatic mode switching algonthms, of contemporary dual-chamber pacemakers, prevent rapid ventricular pacing in response to SVT by temporary during automatic mode switching in the response to SVT, the DDI(R) mode becomes functionally indistinguishable from VVI(R) mode. In patients with varying degrees of AV block, paroxysmal SVT, and relatively normal atrial chronotropic function, automatic mode switching during SVT provides the benefit of the DDD(R) mode during sinus rhythm, thereby obviating the hemodynamic disadvantages of continuous pacing in the nonatrial tracking DDI(R) mode. This article is the second part of a two-part series

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