{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:49:45Z","timestamp":1747187385482,"version":"3.40.5"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Exercise capacity is an important aspect of quality of life in patients undergoing pacemaker implantation. Device algorithms for ventricular pacing avoidance have been developed to avoid unnecessary and potentially harmful effects of right ventricular pacing. However, little data exists on the immediate response of these algorithms to sudden AV block during exercise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The ventricular pacing avoidance algorithms of four pacemaker manufacturers were tested in an ex\u2010vivo model. The RSIM\u20101500\u2010USB Device\u2010Interactive Heart Simulator (Rivertek Medical Systems, Inc.) was used to simulate three different scenarios: the first one starting with an initially conducted atrial pacing rate of 60\u00a0min<jats:sup>\u22121<\/jats:sup>, the second one starting with an atrial rate of 120\u00a0min<jats:sup>\u22121<\/jats:sup> and finally a scenario starting with an atrial rate of 150\u00a0min<jats:sup>\u22121<\/jats:sup>. In all three scenarios, the initially conducted atrial rate was followed by a sudden, long lasting episode of third\u2010degree AV\u2010block. The response to those scenarios was recorded for each of the (brand\u2010specific) ventricular pacing avoidance algorithms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the first scenario, the simulation resulted in a ventricular pause of 1333\u00a0ms (Boston Scientific), 2000\u00a0ms (Medtronic and Microport), and 2340\u00a0ms (Biotronik). In the second and third scenario, different results were observed across devices. All simulations of the second and third scenario resulted in repetitive 2:1 block response (during eight cycles) in Boston Scientific and Biotronik devices. These scenarios were confirmed in patient cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Simulator based observations of unanticipated pacemaker\u2010induced 2:1 block response during exercise may explain clinical symptoms experienced by some patients having a two\u2010chamber pacemaker.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14239","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T09:36:13Z","timestamp":1617874573000},"page":"943-951","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical symptoms of limited exercise capacity linked to AAI\u2010DDD functionality: An in silico and in vivo approach"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5368-2223","authenticated-orcid":false,"given":"Ward","family":"Heggermont","sequence":"first","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"},{"name":"Cardiovascular Research Institute Maastricht Maastricht University  Universiteitssingel 50 Maastricht AZ\u20106202 The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0222-6882","authenticated-orcid":false,"given":"Konstantinos","family":"Iliodromitis","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koen","family":"Van Bockstal","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos","family":"Backers","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chirik\u2010Wah","family":"Lau","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieter","family":"Missiaen","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"De Cooman","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willy","family":"Timmermans","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Geelen","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1424-114X","authenticated-orcid":false,"given":"Tom","family":"De Potter","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center Onze\u2010Lieve\u2010Vrouw Hospital Aalst  Moorselbaan 164 Aalst B\u20109300 Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00085-4"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)90025-V"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.10.072"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq443"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162072"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-304905"},{"key":"e_1_2_12_8_1","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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