What type of pacing is best for a patient with aortic stenosis experiencing third-degree AV block?

For a patient with aortic stenosis experiencing third-degree AV block, atrium-ventricle (DDD) pacing is the most appropriate choice. This type of pacing allows for the preservation of atrial contraction and coordination with ventricular pacing, ensuring that both the atrium and ventricle beat in a synchronized manner.

In the context of aortic stenosis, maintaining proper hemodynamics is critical. The DDD pacing modality enables the atrium to stimulate the ventricle only when appropriate, which supports effective filling of the ventricles and optimizes cardiac output. This is especially important in patients with structural heart disease, such as those with aortic stenosis, where adequate filling and ejection are crucial for maintaining function.

Atrial pacing (AAI) would not be suitable because, in the presence of complete heart block, the impulses generated in the atrium would not be conducted to the ventricle, leading to a lack of ventricular contraction. Conversely, ventricular pacing (VVI) would result in a loss of the coordinated atrial–ventricular contraction and could lead to compromised hemodynamics, especially in a patient with aortic stenosis. Dual-ventricle (DVI) pacing is typically used in specific cases