Treatment and Device programming to avoid RNRVAS
To the best of our knowledge, there are no algorithms specifically for detection or termination of RNRVAS in the devices available today. Certain adjustments in device programs may prevent or terminate RNRVAS1,2,8,11 and we recommend that as many of these modifications as possible be included in the upcoming device algorithms. (i) Decreasing lower rate limit, (ii) short AV delay or automatically shortening AV delay, (iii) decreased sensor indicated upper rate or turning off R mode, (iv) shortening PVARP or programming a rate dependent PVARP; (v) programming non-competitive atrial pacing, (vi) programming ventricular pacing decreasing algorithms when the patient’s AV conduction is functional (MVP, AAI-SafeR, or RhythmIQ). We also recommend meticulous measurement of atrial threshold and programming the pace amplitude considering safety margins to prevent loss of capture.