Module 1
Topic 3
Lesson 9

Extra-stimulus pacing

Baris Akdemir
Head of EP

What will you learn?

  • how to conduct one of the most important manoeuvres
  • what to expect and pay attention to
  • how to avoid potential pitfalls

About this scenario

How to do extra-stimulus pacing?

1. Pick channel with a good quality and good capture (usually CS or HRA for atrial stimulation and RVA for ventricular one).

2. Set stimulation mode to extra-stimulus pacing.

3. Set S1 pacing CL lower than heart CL (i.e. 500 ms) - you want to be faster than the heart itself.

4. Set S2 lower than S1 i.e. 480 ms – you determine starting S1-S2 coupling interval at 480 ms. This means that first S2 stimulus will be delivered 480 ms after last S1 stimulus

5. Set numbers of beats in train - you determine how many S1 pacing signals (drive train) should be delivered prior to S2 pacing  (usually 7-8)

6. Set Rest Time between sets to 2 or 3 seconds in order to give patient and his heart a break between sets. This determines how low stimulator will wait after delivery of S2 pacing prior to new S1 drive train.

7. Set S2 limit to 200 ms - you want to have a safety limit and avoid S2 stimulation below 200 ms.

8. Set Pre-Int -10 ms - this means simulator will decrease S1-S2 coupling interval by 10 ms every new S1-S2 train. If you choose +10 ms it will add extra 10ms in every round.