Pacing Mode in Permanent AF — EECC MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: E — VVI(R) mode — atrial sensing/pacing is unnecessary in permanent AF; DDD mode in AF can cause pacemaker-mediated complications including mode switching issues and unnecessary atrial pacing into a fibrillating atrium
In permanent AF, the atrial channel of a DDD pacemaker serves no useful purpose and can cause problems: (1) inappropriate atrial tracking (if AF waves are sensed as P waves, causing rapid paced ventricular response up to the upper tracking rate); (2) mode switch algorithm activation/deactivation causing rate instability; (3) unnecessary atrial pacing into a fibrillating atrium (energy waste, no haemodynamic benefit). Reprogramming to VVI(R) (ventricular demand pacing with rate response) is recommended. The rate response sensor ensures appropriate heart rate increase during activity. The 2021 ESC Pacing Guidelines recommend: (1) VVIR for permanent AF; (2) if AF is paroxysmal and may revert to sinus, maintaining DDDR with optimised mode-switch parameters is appropriate.
Reference: ESC (2021): Guidelines on Cardiac Pacing and CRT