# Temporary Pacing Simulator: A Training Tool for Clinicians
## 2 Materials and Methods
### The Encapsulation of the Simulator on a User Interface
#### 2.5.5 Pacing Flows and TP Thresholds Settings  
In the sections above, we detailed the main steps and processes executed when a baseline rhythm and a pacing mode are selected. This section delves into the possible scenarios based on the selected pacing mode: atrial, ventricular, or dual pacing.  
The pacing mode parameter is crucial in determining the subsequent steps and choices available to the user during the simulation. As shown in Figure 1, each pacing mode triggers different user paths within the simulator.  
When the user selects AOO or AAI pacing modes, the user interface enables the atrial pacing flow path, illustrated in Figure 5. In AAI mode, all atrial elements of the interface are enabled. These elements include atrial sensitivity threshold failures such as undersensing and oversensing, atrial capture threshold failures such as ALOC, and the atrial capture and sensitivity flows. Users can directly select sensitivity and capture threshold failures to observe their real-time impact on ECG, ABP, and CVP signals. In AOO mode, only the atrial capture threshold failures and the atrial capture threshold flow are enabled. This is due to the specific relevance of these functions to AOO pacing mode.  
When the user selects VOO or VVI pacing modes, the interface enables the ventricular pacing flow path as illustrated in Figure 6. In VVI mode, all ventricular elements of the interface are enabled. These elements include ventricular sensitivity threshold failures such as undersensing and oversensing, ventricular capture threshold failures such as VLOC, and the ventricular capture and sensitivity flows. Users can directly select sensitivity and capture threshold failures to see their effects on ECG, ABP, and CVP signals in real-time. In VOO mode, only the ventricular capture threshold failures and the ventricular capture threshold flow are enabled.  
When the user selects DDI or DOO pacing modes, the interface enables the dual pacing flow path, illustrated in Figure 7. In DDI mode, all elements of the interface are enabled. These elements include sensitivity and capture threshold failures for both atrial and ventricular pacing, all capture and sensitivity flows for comprehensive simulation, and the AV delay flow, which incorporates settings to simulate the synchronization between pacing the atria and the ventricles. In DOO mode, only the capture threshold failures, and atrial and ventricular pacing flows are enabled. This is due to the specific requirements of the DOO pacing mode.  
The sensitivity, capture, and AV delay flows are explained in detail in the sections below. This comprehensive approach ensures that users can explore the full range of pacing  
Figure 5: The Atrial Pacing Flow—This flowchart illustrates the sequence of steps and choices a user can make when selecting an atrial pacing mode. In AAI mode, all elements are enabled, whereas in AOO mode, only the atrial capture threshold failures and atrial capture threshold flow are enabled.  
scenarios and their implications, enhancing their understanding and training in temporary cardiac pacing.