October 2018

Ventricular pacing at rest causing palpitations

Jason Collinson – Chief Cardiac Physiologist
Essex Cardiothoracic Centre, Basildon and Thurrock University Hospital
Twitter: @cardiacjase


A 68 year old patient with a history of brady-tachy syndrome and implanted with a DDD pacemaker presented with palpitations.  A device interrogation was requested after telemetry monitoring showed ventricular pacing at 100 bpm with the patient at rest.  The pacemaker was interrogated and the presenting EGM is shown in figure 1. The device settings are displayed below.

Mode: DDD
LR/UR: 60/130 bpm
AV delay Rest/Exercise: 155/80 ms
AV delay paced/sensed Offset: 65ms
PVAB: 150 ms
Mode switch: On

Figure 1
Presenting EGM recorded on pacemaker interrogation, channel 1 displays the atrial EGM, channel 2, the ventricular EGM and channel 3 the marker channel.


From the options below having seen this EGM what programming change would you make?

  • No change normal function

  • Increase atrial sensitivity

  • Turn off rate adaptive pacing

  • Shorten the PVAB

  • Increase maximal tracking rate