Cardiology In Critical Care

Temporary A-V Sequential Pacemaker Insertion

PURPOSE: To outline the procedure for using the Medtronic A-V Sequential Pacemaker.


  1. To provide a variety of temporary modalities, i.e. asynchronous atrial or ventricular pacing, demand ventricular pacing, asynchronous, or demand A-V sequential pacing.
  2. To pace the atrium and ventricles in sequence, thereby allowing for more atrial contribution to ventricular filling and normal conduction to ventricles when the A-V node is conducting normally.
  3. The dual-chamber generator can be used as a single-chamber generator; however, dual chamber asynchronous pacing can be performed. This pacemaker senses only ventricular activity but is capable of pacing both the atrium and the ventricle.

INDICATIONS: Symptomatic bradycardia; symptomatic bradycardia, and varying degrees of A-V block in association with acute myocardial infarction, and electrophysiological studies.

CONTRAINDICATIONS: A-V sequential pacing does not depend on a functioning AV conduction system; therefore, there are no absolute contraindications to its use. In the presence of fibrillation and flutter, atrial capture is usually not possible.


  1. Atrial and ventricular pacing wires
  2. A-V pulse generator
  3. Equipment per Infection Control SOP for Central Line Insertions
  4. EKG with recorder
  5. Defibrillator
  6. Emergency cart.



1. Follow procedure as in transvenous pacemaker insertion. 1. Procedure same except for connecting of electrode to pacemaker generator.
2. Connect atrial electrode to atrial output terminals, connecting positive and negative electrode terminals to respective positive and negative output terminals. 2. Secure connections are essential for proper conduction of pacemaker energy.
3. Connect ventricular electrode to ventricular output terminals, connecting positive and negative electrode terminals to respective positive and negative output terminals. 3. Secure connections are essential for proper sensing and conduction of pacemaker energy.
4. Set A-V interval control at desired level. 4. Usually set to the normal PR interval. In patients with intermittent second degree block, the A-V interval is set above the patient’s normal PR interval, allowing for normal conduction as well.
5. Set remainder of settings as described in transvenous pacing procedure. 5. Set fast enough to optimize cardiac output and blood pressure without causing myocardial ischemia.

All comments and questions about content at this site should be sent to Nurse Bob

Return Back To Home 

There have been Visitors to this website.

This page last updated 07/25/10