- Two General Indications for permanent pacemaker (PPM) implantation
- 1) Symptomatic sinus bradycardia with rate <40bpm
- 2) High grade or symptomatic AV block
- Pacing is generally not indicated in asymptomatic sinus bradycardia
- There are Four main rhythms that are seen with DDD
- 1) Normal sinus rhythm
- pacemaker is totally inhibited due to acceptable intrinsic sinus rate and AV conduction
- 2) Atrial sensing and ventricular pacing
- Sinus rate is above the set rate (inhibited atrial pacing) with prolonged AV conduction (triggered ventricular pacing)
- 3) Atrial pacing, normally conducted to the ventricle with native QRS
- Atrial pacing is triggered by sinus bradycardia in the setting of normal AV conduction (inhibited ventricular pacing)
- 4) AV sequential pacing
- Both atrial and ventricular pacing are triggered due to sinus brady and prolonged AV conduction
- 1) Normal sinus rhythm
SCVMC IM Chief Resident Blog 