Emedinews: Dr Good Dr Bad: A patient with chronotropic insufficiency (i.e. the inability of the sinus rate to accelerate) was to undergo pacing.

Situation: A patient with chronotropic insufficiency (i.e. the inability of the sinus rate to accelerate) was to undergo pacing.
Dr Bad: DDD pacemaker can be used.
Dr Good: Either WIR or DDDR pacemaker should be used.
Lesson: Chronotropic insufficiency is a contraindication for DDD pacemaker. In these situations, a rate–adaptive or "physiologic" pacemaker is indicated (WIR or DDDR).