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Clinically oriented device programming in bradycardia patients

part 1 (sinus node disease). Proposals from AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Ziacchi, Matteoa,*; Palmisano, Pietrob,*; Biffi, Mauroa; Ricci, Renato P.c; Landolina, Mauriziod; Zoni-Berisso, Massimoe; Occhetta, Eraldof; Maglia, Giampierog; Botto, Gianlucah; Padeletti, Luigii; Boriani, Giuseppej on behalf of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)

Journal of Cardiovascular Medicine: April 2018 - Volume 19 - Issue 4 - p 161–169
doi: 10.2459/JCM.0000000000000630
Focused issue on arrhythmias: Position statements

Modern pacemakers have an increasing number of programable parameters and specific algorithms designed to optimize pacing therapy in relation to the individual characteristics of patients. When choosing the most appropriate pacemaker type and programing, the following variables must be taken into account: the type of bradyarrhythmia at the time of pacemaker implantation; the cardiac chamber requiring pacing, and the percentage of pacing actually needed to correct the rhythm disorder; the possible association of multiple rhythm disturbances and conduction diseases; the evolution of conduction disorders during follow-up. The goals of device programing are to preserve or restore the heart rate response to metabolic and hemodynamic demands; to maintain physiological conduction; to maximize device longevity; to detect, prevent, and treat atrial arrhythmia. In patients with sinus node disease, the optimal pacing mode is DDDR. Based on all the available evidence, in this setting, we consider appropriate the activation of the following algorithms: rate responsive function in patients with chronotropic incompetence; algorithms to maximize intrinsic atrioventricular conduction in the absence of atrioventricular blocks; mode-switch algorithms; algorithms for autoadaptive management of the atrial pacing output; algorithms for the prevention and treatment of atrial tachyarrhythmias in the subgroup of patients with atrial tachyarrhythmias/atrial fibrillation. The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients’ clinical features.

aInstitute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna

bCardiology Unit, ‘Card. G. Panico’ Hospital, Tricase

cDivision of Cardiology, San Filippo Neri Hospital, Rome

dDivision of Cardiology, Ospedale Maggiore, Crema

eDepartment of Cardiology, ASL 3, Padre A Micone Hospital, Genoa

fDivision of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara

gCardiology – Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro

hS. Anna Hospital, Como

iDepartment of Cardiology, Ospedale Careggi, Florence

jCardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy

Correspondence to Prof. Giuseppe Boriani, MD, PhD, FESC, Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy Tel: +39 059 4225836; fax: +39 059 4224498; e-mail:

Received 26 October, 2017

Revised 5 January, 2018

Accepted 11 January, 2018

© 2018 Italian Federation of Cardiology. All rights reserved.