Up-righting Dual-Chamber Cardiac Pacing. The Story of Managed
Abstract: A significant milestone in cardiac pacing occurred
approximately two decades ago when the primary operating mode was
reimagined to more closely mimic normal top-down cardiac activation.
Managed Ventricular Pacing (MVP™) was an unprecedented dual-chamber mode
as it preferentially paced the right atrium in the AAI/R mode and
simultaneously protected against transient heart block, but only in the
instance of a dropped ventricular beats. At the time, dual chamber DDD/R
with atrial based timing and programmable atrioventricular (AV) delay
was the state of the art. MVP “unlocked” conventional dual-chamber
pacing by not consistently requiring a 1:1 atrioventricular relationship
as defined by an AV delay during its primary operating mode (i.e.
AAI/R+). Described herein is the remarkable story of MVP, conceived
before the pivotal and highly supportive Dual-Chamber and VVI
Implantable Defibrillator (DAVID) Trial was introduced and rooted in
lessons learned from “first-in man” permanent His bundle pacing.