Module 1
Topic 3
Lesson 8

Incremental pacing

Victor Waldmann

What will you learn?

  • how to conduct incremental pacing
  • what this basic manoeuvre tells you about the patient heart
  • what is the normal response

About this scenario

  • Atrial pacing train followed by an atrial extrastimuli
  • The atrial extrastimuli is progressively shortened (10 ms by 10 ms)
  • In case of AV conduction through the AV node, the AH interval progressively increases (because of the decremental properties of the AV node), the HV interval remains stable
  • An AH jump (>50 ms) between two consecutives sequences (second extrastimuli 10 ms shorter) is suggestive of a conduction through a slow pathway (block through the fast pathway)
  • In case of antegrade accessory pathway, the AH interval increases whereas the AV interval remains stable so the HV interval becomes negative