Prediction of Wenckebach behavior and block response in DDD pacemakers

At higher atrial rates, the behavior of a DDD pulse generator will depend on the atrial rate or spontaneous atrial interval (SAI) and the settings of the pacemaker: upper rate interval (URI), atrioventricular interval (AVI), and atrial refractory interval (ARI). An algorithm was developed enabling the prediction of the degree of Wenckebach block using the parameters mentioned above. In the absence of the programmed settings of the pacemaker, these parameters can be determined by noninvasive methods. AVI can be measured by application of a magnet over the pulse generator, while URI and ARI can be estimated during chest wall stimulation by progressively increasing the frequency of the external extrastimuli. The use of the formula in combination with chest wall stimulation allows the evaluation of the proper functioning of any DDD pacemaker during exercise and in patients with atrial rhythm disturbances, even when no information about the pacemaker settings is available.