Beyond the Basics: Device Optimization and Tachycardia Dilemmas in Daily Practice

How to Session 5: PPM Programming: What Matters Most (For Cardiologist)

The session "How to Session 5: PPM Programming: What Matters Most," moderated by Evan Jim Gunawan, MD, delivered a comprehensive, end-to-end guide on permanent cardiac pacing. Opening the session, Rizky Aulia Fanani, MD presented "PPM Programming 101”, where he reviewed the essential anatomy and physiology of conduction disorders while outlining the fundamental steps of pacemaker implantation. Setiawan Widodo, MD, followed with "Mode Matters: Optimizing Pacemaker Therapy", emphasizing the critical need to customize pacing modes, fine-tune timing cycles, and properly interpret atrial and ventricular sensed events to maintain physiological synchrony. Concluding the symposium, Agus Harsoyo, MD, PhD, led "PPM Troubleshooting: Quick Fixes for Common Problems". Highlighting device therapy for symptomatic AV block, he cited the FOLLOWPACE study to advocate for multidisciplinary follow-up. He detailed regular software reprogramming to improve generator longevity, navigate manufacturer-specific algorithms, and manage the clinical impact of automatic reprogramming.

How to Session 6: SVT or VT? When Algorithms Fail—Real ECG Cases (For General Practitioner)

Navigating the gray zone between SVT and VT served as the central theme for "How to Session 6", led by moderator Andrianus Oktovianto, MD, specifically designed to sharpen frontline triage for general practitioners. First, Evan Jim Gunawan, MD, kicked off the session by reviewing basic theories and dissecting why traditional algorithms fall short. He mentioned that surface leads merely provide surrogate clues, which are easily obscured by hidden P waves, myocardial scars, antiarrhythmic medications, or rapid fascicular VT circuits that mimic normal conduction. Alice Inda Supit, MD, carried this diagnostic nuance further by focusing on contrasting features of SVT and VT,  like AV dissociation and typical bundle-branch patterns, urging attendees to weigh positive predictive values carefully without overlooking aberrant SVT or pre-excitation mimickers. Closing with bedside application, Muhammad Rafdi Amadis, MD, worked through practical case studies using the Brugada and Vereckei criteria. He highlighted the importance of assuming wide-complex tachycardia as VT until definitive evidence proves otherwise, always grounding algorithmic interpretations in thorough clinical history and immediate hemodynamic status.