[Dual chamber pacemakers: common problems and how to treat them]

In the last ten years the technology in Electrophysiology and Cardiac Parcing has advanced rapidly until the arrive of the implantable cardioverter defibrillator for the prevention of Sudden Death and also to the three chamber pacing for ventricular resinchronization as a treatment for advanced heart failure. In the middle of these we have dual chamber pacemakers. The increasing expectative of life worldwide gives the need and more frequency of implanting dual chamber pacemakers with the exception of the patient with chronic atrial fibrillation. For these reasons, it is important not only to detect the common problems of the dual chamber pacemakers but how to treat them. In this review we will define pacemaker pseudomalfunction: the identification of fusion and pseudofusion beats; the normal pacemaker functions that could be confused with malfunction. About malfunction it will be described the causes and the way for treating oversensing, undersensing, loss of capture, loss of output; how to identify and to treat pacemaker reset, myopotentials stimulation, pacemaker syndrome and finally pacemaker-mediated tachycardia.