The Story of Managed Ventricular Pacing.

A significant milestone in cardiac pacing occurred approximately two decades ago, when the primary operating mode was reimagined to more closely mimic normal top-down cardiac activation. When introduced, Managed Ventricular Pacing (MVP™; Medtronic, Minneapolis, MN, USA) was an unprecedented dual-chamber mode as it preferentially paced the right atrium in the AAI/R mode and simultaneously protected against transient heart block, albeit only in the instance of dropped ventricular beats. At the time, dual-chamber DDD/R with atrial-based timing and programmable atrioventricular delay was state of the art. MVP™ "unlocked" conventional dual-chamber pacing by not consistently requiring a 1:1 atrioventricular relationship during its primary operating mode (ie, AAI/R+). Ultimately, MVP™ emerged as a primitive means to promote His-Purkinje activation, and it is not a coincidence that its roots can be traced back to first-in-man permanent His-bundle pacing.