179 results match your criteria Pacemaker-Mediated Tachycardia
J Electrocardiol 2018 Nov - Dec;51(6):1023-1028. Epub 2018 Aug 17.
IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.
While the implantable pacemaker has initially been developed to treat symptomatic bradycardia, we demand of modern devices that they also function properly during exercise. In recent years, device manufacturers have implemented multiple proprietary algorithms which aim to improve pacemaker function by avoiding unnecessary right ventricular pacing, optimizing atrial refractory periods and diagnosing pacemaker mediated tachycardia. When activated, these algorithms may save the associated EGM into the device memory which enables later analysis by remote monitoring or device interrogation. Read More
J Arrhythm 2018 Oct 22;34(5):572-575. Epub 2018 Jun 22.
Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.
A 69-year-old man, who had undergone surgery for mitral and tricuspid regurgitation with the Maze procedure for paroxysmal atrial fibrillation, was admitted with an episode of syncope due to sick sinus syndrome. Three days after implantation of a dual-chamber pacemaker (Accent MRI™, St. Jude Medical Inc. Read More
J Arrhythm 2018 Oct 3;34(5):485-492. Epub 2018 Aug 3.
Cardiac Rhythm Management Department MonashHeart Monash Medical Centre Melbourne Australia.
Pacemakers can be directly involved in initiating or sustaining different forms of arrhythmia. These can cause symptoms such as dyspnea, palpitations, and decompensated heart failure. Early detection of these arrhythmias and optimal pacemaker programming is pivotal. Read More
Pacing Clin Electrophysiol 2018 Nov 19;41(11):1549-1551. Epub 2018 Sep 19.
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland.
J Cardiovasc Electrophysiol 2018 Dec 25;29(12):1721-1723. Epub 2018 Sep 25.
Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Card Fail 2018 Jul 17. Epub 2018 Jul 17.
Department of Medicine, Cardiology Division, Larner College of Medicine at the University of Vermont, Burlington, Vermont. Electronic address:
Background: Diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) are associated with myocardial fibrosis and concentric left ventricular hypertrophy (LVH). In a preclinical model of LVH, we demonstrated that a moderate increase in heart rate can reduce interstitial fibrosis and improve LV compliance. We therefore hypothesized that moderately elevated heart rates can be used to beneficially modify the myocardial substrate in patients with diastolic dysfunction and HFpEF. Read More
J Arrhythm 2018 Jun 22;34(3):309-311. Epub 2018 May 22.
Division of Cardiovascular Disease University of Alabama at Birmingham Birmingham Alabama USA.
A 64-year-old man with a history of congestive heart failure secondary to nonischemic cardiomyopathy, mitral and aortic valve replacements, and biventricular cardioverter-defibrillator placement, developed a tachycardia. The tachycardia exhibited a biventricular paced rhythm with a short R-P interval and concentric atrial activation sequence within the coronary sinus, suggesting that the tachycardia might be a pacemaker-mediated tachycardia (PMT). However, the tachycardia was diagnosed as counterclockwise cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), and linear ablation of the CTI eliminated the tachycardia. Read More
Clin Case Rep 2018 Jun 14;6(6):1040-1044. Epub 2018 Apr 14.
Division of Cardiology Hospital Ramos Mejia Buenos Aires Argentina.
Inverted connection of the atrial and ventricular leads is an unusual circumstance during the implantation of a dual-chamber pacemaker. Yet, PMT may present in the absence of complex mechanisms. The detection and termination algorithms used by the device proved to be efficient for the adequate diagnosis and treatment. Read More
J Arrhythm 2018 04 9;34(2):213-215. Epub 2018 Mar 9.
Department of Cardiology Turkiye Yuksek Ihtisas Training and Research Hospital Health Sciences University Ankara Turkey.
Acta Clin Belg 2018 Dec 21;73(6):439-443. Epub 2018 Feb 21.
a Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia.
Objective And Importance: Endless loop tachycardia or pacemaker-mediated tachycardia, and atrioventricular desynchronization arrhythmia or repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are two forms of reverse impulse conduction - ventriculoatrial (VA) synchrony. Although VA synchrony can theoretically cause aggravation of heart failure, clinical cases describing severe consequential heart failure are lacking.
Clinical Presentation And Intervention: We describe a case of a 60-year-old patient who underwent primary percutaneous coronary intervention and mitral valve surgery. Read More
Indian Pacing Electrophysiol J 2018 May - Jun;18(3):108-111. Epub 2018 Jan 5.
Biotronik, Berlin, Germany.
This report describes the occurrence of desynchronization in a patient with a cardiac resynchronization device programmed with an active pacemaker-mediated tachycardia algorithm based on AV delay modification. Desynchronization was precipitated by sinus tachycardia and the abrupt return of the prevailing AV delay that followed the periodic prolongation of the AV delay mandated by activity of the algorithm. Prevention of desynchronization in this setting requires programming a right ventricular upper rate interval longer than the sum of the programmed ventriculoatrial interval and the AV delay. Read More
J Am Heart Assoc 2017 Dec 23;6(12). Epub 2017 Dec 23.
Asklepios Klinik St. Georg, Hamburg, Germany.
Background: Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker-based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals.
Methods And Results: Patients indicated for dual-chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Read More
Card Electrophysiol Clin 2017 09;9(3):365-382
Heart and Vessels Department, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; IRCCS Multimedica, Cardiology Department, Via Milanese, 300, 20099 Sesto San Giovanni, Italy.
The sinus node is the primary cardiac pacemaker from which the wavefront of activation proceeds through bundles of atrial fibers to the atrioventricular node. Left atrial activation proceeds along the Bachmann bundle and lower right atrium, determining P-wave morphology. Electrocardiogram reveals ectopic or retrograde atrial activation, wandering pacemaker activity, or artificial pacemaker-mediated atrial depolarization. Read More
Europace 2017 Aug;19(8):1342
CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France.
J Electrocardiol 2017 Jul - Aug;50(4):504-506. Epub 2017 Feb 20.
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina.
A 70-year-old man, who previously received a dual chamber pacemaker for paroxysmal AV block (Sorin Symphony DR 2550), was noted on telemetry to have multiple episodes of rapid ventricular pacing at approximately 120bpm. Evaluation of the telemetry strips revealed that all of the rapid ventricular pacing episodes were initiated by brief runs of escape junctional rhythm. Programmed bradycardia parameters were AAI SafeR with lower rate limit of 50bpm. Read More
Gen Thorac Cardiovasc Surg 2017 Oct 28;65(10):598-601. Epub 2017 Feb 28.
Cardiovascular Surgery, Keio University, Minato, Japan.
Cardiac resynchronization therapy (CRT) has been increasingly performed in patients having heart failure with dyssynchrony. We report a successful case of total thoracoscopic left ventricular (LV) lead implantation in CRT. A 77-year-old man with marked dyssynchrony of the LV wall motion and a low ejection fraction (EF17%) due to pacemaker-mediated cardiomyopathy was referred to us. Read More
J Electrocardiol 2016 Jul-Aug;49(4):522-9. Epub 2016 Apr 22.
Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
Introduction: The incidence of pacemaker-mediated tachycardia (PMT) varies as a function of patient characteristics, device programming and algorithm specificities. We investigated the efficacy of the Boston Scientific algorithm by reviewing PMT episodes in a large device population.
Methods: In this multicenter study, we included 328 patients implanted with a Boston Scientific device: 157 non-dependent patients with RYTHMIQ™ activated (RYTHMIQ group), 76 patients with permanent AV-conduction disorder (AV-block group) and 95 Cardiac Resynchronization Therapy patients (CRT group). Read More
Heart Rhythm 2016 08 19;13(8):1612-7. Epub 2016 Apr 19.
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York.
Background: Current cardiac devices cannot always differentiate between pacemaker-mediated tachycardia (PMT) and tracking of sinus or atrial tachycardia. We previously derived a novel algorithm for distinguishing the 2 mechanisms based on the specific termination response to postventricular atrial refractory period extension, atrial rates, and changes in atrial electrogram morphology.
Objective: The purpose of this study was to evaluate how this algorithm would have performed in a clinical setting based on previously recorded PMT events. Read More
Heart Rhythm 2016 08 2;13(8):1739-47. Epub 2016 Apr 2.
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia. Electronic address:
Similar to endless loop tachycardia (ELT), repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) is a ventriculoatrial (VA) synchrony pacemaker-mediated arrhythmia. RNRVAS was first described in 1990 and can only occur in the presence of retrograde VA conduction and dual-chamber or cardiac resynchronization devices with tracking (P-synchronous ventricular pacing such as DDD, DDDR) or nontracking pacing modes that allow AV-sequential pacing (DDI, DDIR). RNRVAS is promoted by (1) high lower rate limit or any feature that allows rapid pacing, (2) long AV intervals, or (3) long postventricular atrial refractory period (PVARP). Read More
J Electrocardiol 2016 Jul-Aug;49(4):509-11. Epub 2016 Mar 11.
Department of Clinical and Experimental Medicine, University of Messina.
A 59-year-old woman with a history of congestive heart failure, who previously received a biventricular cardioverter-defibrillator was admitted with dyspnea and peripheral edema. She was noted on telemetry to have multiple self-terminated episodes of rapid ventricular pacing, consistent with pacemaker-mediated tachycardia. All episodes started after three consecutive ventricular extrasystoles. Read More
Heart Rhythm 2016 06 17;13(6):1266-73. Epub 2016 Feb 17.
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
Background: In Boston Scientific dual-chamber devices, the RYTHMIQ algorithm aims to minimize right ventricular pacing.
Objective: We evaluated the performance of this algorithm determining (1) the appropriateness of the switch from the AAI(R) mode with backup VVI pacing to the DDD(R) mode in case of suspected loss of atrioventricular (AV) conduction and (2) the rate of recorded pacemaker-mediated tachycardia (PMT) when AV hysteresis searches for restored AV conduction.
Methods: In this multicenter study, we included 157 patients with a Boston Scientific dual-chamber device (40 pacemakers and 117 implantable cardioverter-defibrillators) without permanent AV conduction disorder and with the RYTHMIQ algorithm activated. Read More
Pacing Clin Electrophysiol 2016 Mar 30;39(3):302-4. Epub 2015 Oct 30.
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York.
Pacing Clin Electrophysiol 2015 Dec 5;38(12):1489-98. Epub 2015 Nov 5.
Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
Pacemaker-mediated tachycardia (PMT) is the term used to describe a repetitive sequence of sensed retrograde P waves followed by ventricular pacing at or below the maximum tracking rate. The following events can promote atrioventricular (AV) dissociation, retrograde conduction, and the onset of PMT: ventricular or atrial extrasystole, an excessively long programmed AV delay, external interference or myopotentials sensed by the atrial channel, atrial sensing or pacing failure, the absence of postventricular atrial refractory period extension after removal of a magnet, and VDD pacing at a higher rate than sinus rate. In contemporary devices, each manufacturer has a proprietary algorithm to detect and terminate PMT. Read More
Europace 2015 Sep 11;17(9):1453. Epub 2015 Jun 11.
Department of Cardiovascular Medicine, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia.
Intern Med 2015 1;54(9):1063-6. Epub 2015 May 1.
Division of Cardiology, Cardiovascular Center, Sendai Kousei Hospital, Japan.
An 81-year-old woman who had undergone dual chamber pacemaker implantation for sick sinus syndrome was referred to our hospital with drug-refractory common atrioventricular (AV) nodal reentrant tachycardia. Ventricular pacing (Vp) following premature atrial contraction (PAC) with a long AV interval induced ventriculoatrial (VA) conduction, which allowed the tachycardia to be initiated. The sensed AV interval was shortened to 80 ms, allowing Vp during the refractory period of VA conduction. Read More
Pacing Clin Electrophysiol 2015 Sep 5;38(9):1117-20. Epub 2015 Feb 5.
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
Ann Noninvasive Electrocardiol 2015 May 6;20(3):224-39. Epub 2015 Jan 6.
University of Rochester School of Medicine and Dentistry, Rochester, NY.
Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Read More
Pacing Clin Electrophysiol 2015 May 4;38(5):645-50. Epub 2014 May 4.
Florida Heart Rhythm Institute, Tampa, Florida.
Cardiol Clin 2014 May 15;32(2):283-92. Epub 2014 Feb 15.
Division of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA; Division of Cardiology, Veterans Health Administration (VA) North Texas Healthcare System, 4500 South Lancaster Road, Dallas, TX 75216, USA.
Permanent cardiac pacemakers (PPM) are effective in the treatment of bradycardia in a growing number of clinical scenarios. An appreciation of the capacity of PPMs to result in negative hemodynamic and proarrhythmic effects has grown alongside clinical experience with permanent pacing. Such experience has necessitated the development of algorithms aimed at optimizing device functionality across a broad spectrum of physiologic and pathologic conditions. Read More
Exp Clin Cardiol 2013 ;18(1):35-7
Department of Cardiology, University of South Alabama, Mobile, Alabama, USA.
Angina is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back or arm. It is typically aggravated by exertion or emotional stress and relieved by nitroglycerin. Atherosclerotic coronary artery disease is the most common cause of angina. Read More
Heart Rhythm 2014 Feb 1;11(2):328-9. Epub 2013 Nov 1.
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center Los Angeles, California.
J Cardiovasc Electrophysiol 2014 Jan 17;25(1):107-9. Epub 2013 Sep 17.
Ochsner Medical Center, Ochsner Clinical School, Queensland University School of Medicine, New Orleans, Louisiana, USA.
Semergen 2014 Apr 13;40(3):e57-9. Epub 2013 Jun 13.
Servicio de Urgencias, Hospital de Alta Resolución de Écija, Écija, Sevilla, España.
The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Read More
Pacing Clin Electrophysiol 2014 Jan 21;37(1):109-12. Epub 2013 May 21.
Heart Rhythm Service, University Hospital of Wales, Cardiff, UK.
Int J Cardiol 2013 Oct 29;168(4):3300-8. Epub 2013 Apr 29.
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address:
Introduction: Ventriculoatrial (VA) conduction and related pacemaker-mediated tachyarrhythmias (PMT) have not been systematically investigated in a large cohort of patients implanted for symptomatic atrioventricular (AV) block.
Methods And Results: Two hundred fifty consecutive patients (71±14 years, 63% male) implanted for symptomatic second- or third-degree AV block were screened for retrograde VA conduction and related PMTs including endless loop tachycardia (ELT) and repetitive nonreentrant VA synchrony (RNRVAS). After a mean post-implantation period of 38±12 months, AV block was persistent in 137 (55%) and variable in 113 (45%) patients. Read More
Anesth Analg 2013 Feb 24;116(2):307-10. Epub 2012 Dec 24.
Department of Anesthesiology, Stony Brook University Medical Center, HSC L-4, Room 060, Stony Brook, NY 11794, USA.
Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator. Read More
Cardiol J 2012 ;19(4):443-4
Florida Heart Rhythm Institute, Tampa, Florida, USA.
Pacing Clin Electrophysiol 2013 Jan 21;36(1):116-8. Epub 2012 Jul 21.
Florida Heart Rhythm Institute, Tampa, FL 33606, USA.
Europace 2012 Jul 26;14(7):1060-1. Epub 2012 Jan 26.
The Florida Heart Rhythm Institute, Tampa, FL, USA.
This report describes the de novo occurrence of pacemaker-mediated tachycardia (PMT) in a patient with a dual-chamber implantable cardioverter-defibrillator and stable retrograde ventriculoatrial conduction time. The same rate-adaptive post-ventricular atrial refractory period (PVARP) duration had previously prevented PMT. Oversensing of atrial false signals from a defective lead shortened the PVARP with consequent sensing of retrograde conduction. Read More
J Electrocardiol 2012 May-Jun;45(3):336-9. Epub 2012 Jan 26.
Florida Heart Rhythm Institute, Tampa, FL, USA.
We report the initiation of pacemaker-mediated tachycardia by a St Jude implantable cardioverter-defibrillator with a programmed Ventricular Intrinsic Preference algorithm used for minimizing or inhibiting right ventricular pacing. This feature prolongs the atrioventricular (AV) delay periodically to determine if ventricular sensed events follow atrial events. Retrograde ventriculoatrial conduction and pacemaker-mediated tachycardia were initiated by long extended AV delays of 300 and 400 milliseconds. Read More
Pacing Clin Electrophysiol 2012 Apr 28;35(4):e84-6. Epub 2011 Sep 28.
Electrophysiology Division, National Medical Center 20 de Noviembre, ISSSTE, Mexico D.F.
Pacemaker-mediated tachycardia (PMT) remains a clinical problem in patients with dual-chamber pacemaker despite technological advances. The onset mechanism of this tachycardia is sensing of retrograde atrial activation after ventricular stimulation. Repeated retrograde conduction perpetuates tachycardia. Read More
J Electrocardiol 2011 Nov-Dec;44(6):616-21. Epub 2011 Sep 9.
Mayo Clinic Jacksonville Florida, Division of Cardiology, Jacksonville, FL, USA.
The number of patients receiving pacemakers and defibrillators has grown substantially over the last 20 years. In addition, the complexity and sophistication of these devices have increased, making diagnosis of pacemaker problems using the electrocardiogram (ECG) more difficult for clinicians in the emergency department. This article will focus on a few of the pitfalls to be avoided when interpreting paced ECGs. Read More
Heart Rhythm 2011 Aug 3;8(8):1185-91. Epub 2011 Mar 3.
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA.
Background: Dual-chamber pacemaker systems can lead to two forms of pacemaker-facilitated tachycardia: pacemaker-mediated tachycardia (PMT) and tracking of sinus or atrial tachycardia. Current pacemaker algorithms cannot always differentiate between these two tachycardias.
Objective: The purpose of this study was to investigate a novel algorithm for distinguishing the two mechanisms of pacemaker-facilitated tachycardia, which is based on the specific termination response to postventricular atrial refractory period (PVARP) extension. Read More
Heart Rhythm 2011 Apr 27;8(4):636-8. Epub 2010 Dec 27.
Cardiology Division, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Can J Cardiol 2010 Nov;26(9):e340
Department of Cardiology, State Medical Center, Budapest, Hungary.
The case of a patient with a unipolar VVIR, who developed a sensor-driven increased pacing rate at rest following pulse generator replacement, is presented. The cause was pectoral muscle stimulation, which triggered a sensor-driven rate response in the supine position. The possible causes and management are discussed. Read More
Pacing Clin Electrophysiol 2011 May 14;34(5):617-20. Epub 2010 Oct 14.
Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Pacing Clin Electrophysiol 2011 Mar 17;34(3):380-3. Epub 2010 Aug 17.
I Department of Cardiology and Hypertension, University Hospital, Kracow, Poland.
Pacing Clin Electrophysiol 2010 Nov;33(11):1421-4
Institute of Cardiology, University of Debrecen, Debrecen, Hungary.
Heart 2010 Jul 28;96(13):1062. Epub 2010 May 28.
Indian Pacing Electrophysiol J 2010 May 5;10(5):203-4. Epub 2010 May 5.
Malabar Institute of Medical Sciences, Calicut, Kerala, India.