By Charles J. Love
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Extra resources for Cardiac Pacemakers and Defibrillators, 2nd Edition
In this variation of DVI, any time an atrial output is delivered a ventricular output is “committed” as is seen on the third ARS. This “committed” operation is frequently mistaken for undersensing of the ventricular lead. 4 46 4 Cardiac Pacemakers and Defibrillators Fig. 15. DVI-NC (noncommitted) mode will pace both atrium and ventricle but sense only the ventricle. As with DVI-C, P-waves are never sensed. Total inhibition of both atrial and ventricular output occurs only when a QRS is sensed before the end of the AEI.
The purpose of this refractory period is to prevent the ventricular sensing channel from sensing the large atrial pulse. A normal ventricular sensitivity setting is in the range of 2 mV meaning that any electrical signal greater than 2mV will inhibit the ventricular output. 0 V (that is 2500 to 5000 mV), it is easy to see how the ventricular channel could sense the atrial output and assume it saw a QRS. Should ventricular sensing of the atrial output occur, the ventricular output pulse will be inhibited and the patient will not have a ventricular beat.
These responses will not be seen in patients with normal AV node function, as their own AV node will conduct the atrial beats and therefore prevent the effects of this pacemaker behavior from becoming apparent. Block (Multiblock) This type of behavior appears on the surface electrocardiogram in much the same way as second degree (Mobitz-II) AV block. 2:1 pacemaker block will occur when the maximum tracking rate is set to the limits imposed by the TARP (PVARP + AVI). For example, if the AVI is 200 msec and the PVARP is 300 msec, the TARP is 500 msec.
Cardiac Pacemakers and Defibrillators, 2nd Edition by Charles J. Love