Choosing the Device Generator and Leads: Matching the Device with the Patient

This chapter provides a brief summary of the algorithm generally used for deciding which pulse generator, mode selection, and leads are to be usedIt points out specific issues relevant to physiological conduction system pacing and cardiac resynchronization devicesThe chapter also provides direction in choosing the most appropriate pulse generator – pacemaker, internal cardioverter-defibrillator or cardiac resynchronization therapy – and leads for a given patientThe chapter aims to provide practical considerations and a generic approach to determine the type of hardware most appropriate for the patient who is receiving an implantable cardiac deviceIf a patient requires pacing for neurocardiogenic syncope, whether the vasovagal variety or carotid sinus hypersensitivity, dual-chamber pacing is necessary for several reasonsUsing a dual-chamber pacemaker with rate-adaptive capabilities in all patients provides the greatest long-term flexibility, and most patients with symptomatic bradycardia often have associated chronotropic incompetence, or at least the potential for this to occur.