PVC Response Feature
PVC response is nominally On but can be programmed Off.
To program this feature in pacemakers, go to Params -> Additional Features -> PVC Response.
To program this feature in ICDs, go to Params -> Pacing -> Additional Features.
The pacemaker defines a PVC as any ventricular sensed event (refractory or nonrefractory) that follows a ventricular event (pace, refractory sense, or nonrefractory sense) without an intervening atrial event (pace, refractory sense, or nonrefractory sense). In the VDD mode, a ventricular paced event delivered at the Lower Rate and not preceded by an atrial sensed event is also considered a PVC.
Premature Ventricular Contraction (PVC) Response serves one of two purposes, depending on the programmed pacing mode:
- DDDR (including MVP), DDD, and VDD modes – PVC Response is intended to prevent tracking of retrograde P waves generated by PVCs. This response helps prevent initiation of pacemaker-mediated tachycardia.
- DDIR and DDI modes – PVC Response prevents inhibition of atrial pacing that can result from retrograde P-waves generated by PVCs.
The operation of PVC response is described in the diagram below.
Interaction with other features
PVC Response interacts with other pacemaker features as follows:
- The PVC Response feature always enables Non-Competitive Atrial Pacing (NCAP) for one cycle when NCAP is programmed Off. This occurs even when the PVARP extension occurs.
- If Mode Switch is On, PVC Response is temporarily disabled when the pacemaker switches to the non-atrial tracking mode. It is re-enabled upon return to the atrial tracking mode.
If PVC Response is programmed to On and PMTs are observed, consider programming PMT Intervention, or evaluate the atrial and ventricular lead performance or positions, or consider drug therapy to reduce retrograde conduction.
PVC Response Off
PVC Response On
In the EGM strip above:
- PVARP is programmed to 200 ms (shown by small green box).
- After the sensed PVC, PVC Response extends PVARP to 400 ms (shown by red box).
- The retrograde P-wave following the PVC now falls into the extended PVARP, as indicated by its AR annotation.
Sources: Medtronic Adapta™/Versa™/Sensia™ Reference Guide; Medtronic Consulta™ CRT-P Clinician Manual;Medtronic Protecta™ XT DR Clinician Manual; Medtronic Protecta™ XT CRT-D Clinician Manual.