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Comparative Study Herz. 2001 Feb;26(1):2-17. doi: 10.1007/pl00002003.

[Mode-switching algorithms: programming and

usefulness]
[Article in German]
C W Israel 1

Affiliations expand
PMID: 11258106 DOI: 10.1007/pl00002003

Cite

Abstract
Background: Automatic mode switching is defined as the ability of a pacemaker to reprogram itself
from tracking to non-tracking mode in response to atrial tachyarrhythmias, and to regain tracking
mode as soon as the tachyarrhythmia terminates. In contrast to upper rate behavior, mode
switching does not only limit atrial tracking at a certain rate but actively drives the ventricular
pacing rate back to lower rate or sensor rate as long as the atrial tachyarrhythmia persists. In
contrast to DDD with mode switch, AV synchrony may be lost in DDIR mode if the sinus rate
exceeds the sensor rate. DDD pacing with mode switching represents a valuable option in patients
with AV block and paroxysmal atrial tachyarrhythmias. It may prevent the transition from
paroxysmal to permanent atrial fibrillation after AV node ablation to a higher extent than VVI(R)
pacing. On the other hand, patients with sinus node disease and normal AV conduction may benefit
from DDIR mode with long AV interval. Mode switching should provide a rapid, sensitive and
specific detection of atrial tachyarrhythmias, fast switch to non-tracking mode without ventricular
pacing at the upper rate limit, adequate ventricular rate during the atrial tachyarrhythmia, rapid,
sensitive and specific detection of conversion to sinus rhythm and fast switch back to tracking
mode. In addition, oscillations between DDD and DDI mode with sudden ventricular rate changes
should be avoided. MODE-SWITCHING ALGORITHMS: To achieve these aims, different mode-
switching algorithms have been developed which all show specific disadvantages: reliable but slow
response to atrial tachyarrhythmias, fast but unspecific switch to non-tracking mode, mode
oscillations, inclination to inadequate mode-switching due to ventricular far-field sensing, failure to
perform modeswitching during atrial flutter or intermittent atrial undersensing. Some of these
problems can be avoided by careful atrial lead implantation providing atrial signals above 2 mV and
avoiding ventricular far-field signals. Programming of mode-switching related parameters (e.g.
atrial rate and number of fast beats required for mode switch), atrial blanking times, and atrial
sensitivity can solve some of the problems with mode switching. Clinical results show a strong
influence of device programming and atrial undersensing on mode-switching performance. Some
data suggest a superiority of fast mode-switching algorithms with regard to clinical symptoms.
However, loss of AV synchrony during sinus rhythm due to premature or inadequate mode
switching may limit the benefit of fast mode switching.

Further developments: Improved performance may be achieved by a combination of different

mode-switching algorithms (e.g. one algorithm for detection of atrial fibrillation, another one for
detection of atrial flutter). In addition, programmability of several algorithms (e.g. mean atrial rate,
beat-to-beat, x out of y) within the same device and atrial cycle-dependent sensitivity adjustment
similar to automatic gain control in implantable defibrillators may further increase the clinical use of
automatic mode switching.

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Cited by 1 article
Predictors of Recurrent Atrial Fibrillation Using Mode Switch Quantification.
Ruisi P, Makaryus JN, Catanzaro JN, Ruisi M, Cedrone A, Makaryus AN, Altman E, Jadonath R, Beldner S.
Cardiol Res. 2013 Oct;4(4-5):135-138. doi: 10.4021/cr292w. Epub 2013 Oct 15.
PMID: 28352435 Free PMC article.

Publication types
Comparative Study
English Abstract

MeSH terms
Algorithms*
Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / therapy
Atrial Fibrillation / diagnosis
Atrial Fibrillation / therapy
Atrial Flutter / diagnosis
Atrial Flutter / therapy
Cardiac Pacing, Artificial* / methods
Electrocardiography
Electrodes, Implanted
Heart Rate
Humans
Pacemaker, Artificial* / standards
Patient Selection
Prospective Studies
Sensitivity and Specificity
Tachycardia / diagnosis
Tachycardia / therapy
Tachycardia, Supraventricular / diagnosis
Tachycardia, Supraventricular / therapy
Time Factors

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