MVP and increased ventricular pacing

Hello to all !
I got my pacemaker in May, 2020, so I'm coming up on 3 years. I have learned a lot since those days when I knew very little about pacemakers. I have gotten along quite well with no problems during that time. I go tomorrow to see my doctor for the first time since May, 2022. The device rep will also be there who I haven't seen since November,2021.

I've learned a lot from the wonderful contributors to this forum and I wanted to ask your thoughts on this.

My question is about my increasing % in ventricular pacing. My 4 transmissions are as follows

February 23, 2022  VP 66.7%, AP25.8%

May 2022 VP 34.1%, AP 20.2%

August 11, 2022 MRI session  VP 51.7%,AP 21.8%

August 31, 2022 regular transmission VP 77.5%, AP 21.9%

December 2, 2022 VP 78%, AP 27.0%

This is all the transmissions I've had in 2022. The report also shows MVP OFF.

Should MVP  be  on ??

4 Comments

Depends

by Penguin - 2023-02-27 15:41:11

Hi DC, 

This is a 'depends' answer.  MVP was designed, as you probably know, to eliminate unnecessary VP.  I don't have a Medtronic device and therefore I'm unsure as to the criteria it uses to determine what is / isnt unnecessary VP and how effective these criteria might be when compared to alternatives such as AVD programming. 

The research re: unnecessary VP and algorithms such as MVP is vague when it comes to people with AV conduction defects. The algorithms work effectively for people with SSS but there is debate over how well they work for people in your situation. 

I think this is something you need to discuss with your pacing team and EP.  

 

Managed Ventricular Pacing (MVP)

by Gemita - 2023-02-27 16:49:42

Dixie Chick, how lovely to hear from you again.  If you feel well, please don't worry about those percentages!  

I recall you posted some settings to the Gallery some time ago and that your AV Delays were quite long.  They sometimes use this setting to manage (minimise) your ventricular pacing.  So I would ask which settings are they using to make sure that your ventricular pacing is kept to a minimum, if indeed it needs keeping to a minimum, since if you need it, you need it?

The MVP algorithm basically provides atrial‐based pacing (AAI/R) with ventricular backup. It can function both in AAI/R and DDD/R modes.  My MVP is switched on because I have no AV restriction.  I am 100 % atrial paced with very little need for ventricular pacing (2-3% last check).

Will you report back please and let us know what you find out?  I hope you have a very helpful review

Studies

by Penguin - 2023-02-27 18:21:06

Hi again, 

I had a quick google and found this research article. https://academic.oup.com/europace/article/16/11/1595/604171 

It gives an indication of what happened when MVP or Search AV+  were used as alternative methods of managing VP on a group of patients with and without AV conduction issues.  It's not a major study but may be of interest.  (I think that Search AV+ is another strategy used by Medtronic in the battle against VP - but please check as I'm no expert on Medtronic algorithms.)

The reference to AT / AF at the end of the article is referring to a known correlation between high burden VP (above 40%) and the acquisition of AT / AF.  However, AT/AF and progression to HF isn't a given and many people report that they are not affected. 

Therefore, please don't panic. Take your best advice from your EP.  

 

MVP and increased pacing %

by Dixie Chick 65 - 2023-02-27 19:07:18

Many thanks to Penguin and Gemita for taking time out to send me your thoughts ! 
 

I read extensively, especially the Medtronic website, and I could never get my mind settled on exactly "when" it should be turned ON. I will read the link you sent Penguin.

And I do have complete confidence in my " team " and will ask them tomorrow and I promise to report back here ! 
Thanks again for responding !

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