Pacing modes indications and contraindications

Mode	Generally agreed upon indications	Controversial indications	Contraindications
VVI/VVIR	Fixed atrial arrhythmias (atrial fibrillation or flutter) with symptomatic bradycardia in the CC patient (VVI) or CI patient (VVIR)	Symptomatic bradycardia in the patient with associated terminal illness or other medical conditions from which recovery is not anticipated and pacing is life-sustaining only	Patients with known pacemaker syndrome or hemodynamic deterioration with ventricular pacing at the time of implant CI patient who will benefit from rate response Patients with hemodynamic need for dual-chamber pacing
AAI/AAIR	Symptomatic bradycardia as a result of sinus node dysfunction; used when AV conduction can be proven normal in the otherwise CC patient (AAI) or CI patient (AAIR)		Sinus node dysfunction with associated AV block either demonstrated spontaneously or during pre-implant testing When adequate atrial sensing cannot be attained
DVI*
VDD^¶/VDDR^Δ	Congenital AV block AV block when sinus node function can be proven normal in the CC patient (VDD) or CI patient (VDDR)		Sinus node dysfunction AV block when accompanied by sinus node dysfunction When adequate atrial sensing cannot be attained AV block when accompanied by PSVT
DDI/DDIR^◊	Need for dual-chamber pacing in the presence of significant PSVT in the CC patient (DDI) or CI patient (DDIR)	Sinus node dysfunction in the absence of AV block in the presence of significant PSVT in the CC patient (DDI) or CI patient (DDIR)	CI patient with a demonstrated need or improvement with rate responsiveness
DDD/DDDR	AV block and sinus node dysfunction in the CC patient (DDD) or CI patient (DDDR) Need for AV synchrony to maximize cardiac output in CC active patients (DDD) Previous pacemaker syndrome	For any rhythm disturbance when atrial sensing and capture is possible for the potential purpose of minimizing future atrial fibrillation and improved morbidity and survival	Presence of chronic atrial fibrillation, atrial flutter, giant inexcitable atrium or other frequent PSVTs When adequate atrial sensing cannot be attained

CC: chronotropically competent (ie, the ability to achieve an appropriate heart rate for a given physiologic activity); CI: chronotropically incompetent (ie, the inability to achieve an appropriate heart rate for a given physiologic activity); AV: atrioventricular; PSVT: paroxysmal supraventricular tachycardia.
* DVI as a stand-alone pacing mode (ie, a pacemaker capable of DVI as the only dual-chamber mode of operation) is obsolete. All primary uses of this mode should be considered individually.
¶ VDD as a stand-alone pacing mode (ie, a pacemaker capable of VDD as the only dual-chamber mode of operation) is currently used primarily as a single-lead VDD system. If a dual-lead system is implanted, then the capability of DDD pacing is desirable.
Δ In current single-lead VDDR pacemakers, P-wave tracking occurs as long as the sinus rate is appropriate. However, in the presence of sinus bradycardia or chronotropic incompetence, the pacemaker operates in the VVIR mode.
◊ DDIR has been supplanted by DDD or DDDR pacemakers with the capability of mode-switching (ie, the pacemaker automatically reprograms to a mode incapable of tracking the atrial rhythm in the presence of an atrial rhythm that the pacemaker classifies as a pathological rhythm). When the pacemaker recognizes the atrial rhythm as being physiological, the pacemaker reprograms to the previously programmed mode.

Graphic 120148 Version 1.0

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Pacing modes indications and contraindications