Managed Ventricular Pacing
MVP Promotes Intrinsic Conduction
A patient's risk of AF doubles with ventricular pacing (DDD-L or DDD-S) vs. atrial pacing (AAIR).1 Even with long AV delays, programmed DDD pacing leads to AF.1
In patients with sinus node dysfunction:
- When ventricular pacing is less than 40%, for each 10% increase in ventricular pacing there is a 54% relative increase in risk for heart failure hospitalization.2
- When ventricular pacing is greater than 40%, a patient's relative risk for heart failure hospitalization remains constant.2
- The risk of atrial fibrillation increases linearly as the percentage of ventricular pacing increases from 0% to 85%.2
Rise of Heart Failure Hospitalization Relative to Ventricular Pacing
Risk of Atrial Fibrillation Relative to Ventricular Pacing
Promoting Intrinsic Conduction Without Compromising Safety
Managed Ventricular Pacing (MVP®) is an atrial-based pacing mode that significantly reduces unnecessary right ventricular pacing 2,3 by primarily operating in an AAI(R) pacing mode while providing the safety of a dual chamber backup mode if necessary.
MVP Operation
References
- Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pederson AK. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Cardiol. August 20, 2003;42(4):614-623. Comment in J Am Coll Cardiol. 2003;42:624-626.
- Sweeney M, Hellkamp A, Ellenbogen K, et al, for the MOde Selection Trial (MOST) Investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107:2932-2937.
- Gillis AM et al, Reduction of unnecessary right ventricular pacing due to the managed ventricular pacing (MVP) mode in patients with symptomatic bradycardia: benefit for both sinus node disease and AV block indications. HRS. 2005 Abstract; AB21-1.
MVP Mode Operation Video
MVP Mode Operation (00:34)
Clinical Evidence
Sweeney MO, Shea JB, Fox V, et al. Randomized pilot study of a new atrial-based minimal ventricular pacing mode in dual-chamber implantable cardioverter-defibrillators. Heart Rhythm. July 2004;1(2):160-167.
Gillis AM, Pürerfellner H, Israel CW, et al. Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease and AV Block. PACE. July 2006;29(7):697-705.
Sweeney MO, Ruetz LL, Belk P, Mullen TJ, Johnson JW, Sheldon T. Bradycardia pacing-induced short-long-short sequences at the onset of ventricular tachyarrhythmias: a possible mechanism of proarrhythmia? J Am Coll Cardiol. August 14, 2007;50(7):614-622.
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. August 2005;16(8):811-817.
Milasinovic G, Tscheliessnigg K, Boehmer A, et al. Percent ventricular pacing with managed ventricular pacing mode in standard pacemaker population. Europace. February 2008;10(2):151-155.
Pürerfellner H, Brandt J, Israel C, et al. Comparison of two strategies to reduce ventricular pacing in pacemaker patients. PACE. February 2008;31(2):167-176.
Sweeney MO, Bank AJ, Nsah E, et al. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med. September 6, 2007;357(10):1000-1008.
Sweeney MO, et al. Severe Atrioventricular Decoupling, Uncoupling, and Ventriculoatrial Coupling During Enhanced Atrial Pacing. J Cardiovasc Electrophysiology. June 12, 2008, online ahead of print.
Kaltman JR, Ro PS, Zimmerman F, et al. Managed ventricular pacing in pediatric patients and patients with congenital heart disease. Am J Cardiol. October 1, 2008;102(7):875-878.
Guidelines
- 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).
- 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 Journal of the American College of Cardiology, Volume 51, Issue 21, 27 May 2008, Pages e1-e62 Andrew E. Epstein, John P. DiMarco, Kenneth A. Ellenbogen, N.A. Mark Estes III, Roger A. Freedman, Leonard S. Gettes, A. Marc Gillinov, Gabriel Gregoratos, Stephen C. Hammill, David L. Hayes, Mark A. Hlatky, L. Kristin Newby, Richard L. Page, Mark H. Schoenfeld, Michael J. Silka, Lynne Warner Stevenson, Michael O. Sweeney.