175 results match your criteria Pacemaker-Mediated Tachycardia


Arrhythmogenic iatrogenesis imperfecta: A decades-long chase down the rabbit hole.

Authors:
Gabriel E Soto

HeartRhythm Case Rep 2021 May 10;7(5):296-300. Epub 2021 Feb 10.

SoutheastHEALTH, Cape Girardeau, Missouri.

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Change in cycle length during pacemaker-mediated tachycardia: What is the mechanism?

Clin Case Rep 2021 May 15;9(5):e04271. Epub 2021 May 15.

Arrhythmia Center Hospital Israelita Albert Einstein São Paulo Brazil.

A thorough understanding of advanced device algorithms designed to promote intrinsic atrioventricular conduction is mandatory to allow appropriate management of arrhythmias induced by pacing, particularly when other types of tachycardia are involved. Read More

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Novel Pacemaker-Mediated Arrhythmia Without Ventriculoatrial Conduction Can Induce Atrial Fibrillation.

JACC Clin Electrophysiol 2021 01;7(1):1-5

Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.

Cardiovascular implantable electronic devices can initiate and sustain pacemaker-mediated arrhythmias. Endless loop tachycardia and repetitive non-re-entrant ventriculoatrial synchrony (RNRVAS) are well-described examples of pacemaker-mediated arrhythmias. However, such arrhythmias only occur in the presence of ventriculoatrial conduction. Read More

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January 2021

Pacemaker-mediated tachycardia in a dual-lead CRT-D: What is the mechanism?

Pacing Clin Electrophysiol 2021 01 8;44(1):151-155. Epub 2020 Nov 8.

Royal Brompton Hospital, London, UK.

A 73-year-old gentleman with dilated cardiomyopathy, left bundle branch block and a left ventricular (LV) ejection fraction of 20% was implanted with two LV leads in a tri-ventricular cardiac resynchronisation therapy defibrillator (CRT-D) trial. As a part of the trial he was programmed with fusion-based CRT therapy with dual LV lead only pacing. The patient presented to local heart failure service 12 years after implant, after a positive response to CRT therapy, with increase in fatigue, shortness of breath and bilateral pitting oedema. Read More

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January 2021

Troubleshooting Pacemaker Behavior: Consequence of Prolonged Ventriculoatrial Conduction.

J Innov Card Rhythm Manag 2020 Sep 15;11(9):4246-4249. Epub 2020 Sep 15.

The University of Kansas Physicians, Heart and Vascular Center, Topeka, KS, USA.

The event of repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) and its course of cardiac device management has been authenticated. However, this context has not been well-documented in the presence of high-degree antegrade heart block. This case report will discuss the challenges of treatment in this subgroup of patients. Read More

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September 2020

"Unreasonable" ventricular pacings.

Ann Noninvasive Electrocardiol 2021 03 21;26(2):e12793. Epub 2020 Aug 21.

First Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.

A 66-year-old man, implanted Abbott dual-chamber pacemaker, was admitted to our hospital due to recurrent palpitation. ECG was recorded on admission, which created a diagnostic confusion: What accounts for the appearance of the VP in the setting of a stable intrinsic atrioventricular (AV) conduction? In this case, we will focus on the logical reasoning in the analysis of Pacing ECG. Read More

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Treatment of atypical pacemaker-mediated tachycardia with ablation of the retrograde atrioventricular nodal pathway.

J Cardiovasc Electrophysiol 2020 05 9;31(5):1213-1217. Epub 2020 Mar 9.

Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

A 25-year-old runner received a single-lead, VDD pacemaker after ablation of AV nodal reentrant tachycardia complicated by intermittent AV block. The rate-adaptive AV delay algorithm (RAAV), which shortens the sensed AV interval (SAV) at faster atrial rates, was programmed to provide a physiologic SAV with exercise. She developed repetitive, atypical, long-RP pacemaker-mediated tachycardia (PMT) because the RAAV shortened the antegrade SAV and retrograde conduction occurred over the slow AV nodal pathway. Read More

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An incessant, symptomatic, and difficult to control tachycardia: What are the treatment options?

J Cardiovasc Electrophysiol 2020 01 19;31(1):263-266. Epub 2019 Dec 19.

Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia.

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January 2020

Ventriculoatrial conduction in patients without high-grade AV block: when is it present?

J Interv Card Electrophysiol 2020 Nov 9;59(2):393-400. Epub 2019 Dec 9.

Gill Heart Institute and VAMC, Cardiology, University of Kentucky, Lexington, KY, USA.

Introduction: Ventriculoatrial (VA) conduction is a critical component in many arrhythmias, has a diagnostic value in electrophysiology study (EPS), and is implicated in pacemaker-mediated arrhythmias. This study sought to characterize retrograde conduction during EPS and to utilize it as a diagnostic tool in patients without AV block.

Methods And Results: Patients with intact AV conduction undergoing EPS were included in this study to systematically evaluate baseline VA conduction. Read More

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November 2020

Closing the Loop: Validation of Implantable Cardiac Devices With Computational Heart Models.

IEEE J Biomed Health Inform 2020 06 11;24(6):1579-1588. Epub 2019 Oct 11.

Objective: Cardiovascular Implantable Electronic Devices (CIEDs) are used extensively for treating life-threatening conditions such as bradycardia, atrioventricular block and heart failure. The complicated heterogeneous physical dynamics of patients provide distinct challenges to device development and validation. We address this problem by proposing a device testing framework within the in-silico closed-loop context of patient physiology. Read More

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Pacemaker Mediated Tachycardia.

J Assoc Physicians India 2019 Aug;67(8):70

Senior Resident, Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh.

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When two hearts do not beat as one - An unusual cause of pacemaker related tachycardia.

J Electrocardiol 2019 Nov - Dec;57:6-9. Epub 2019 Aug 1.

Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Electronic address:

We describe an unusual cause of intermittent rapid ventricular paced rhythm in a patient implanted with a dual chamber pacemaker due to sinus node dysfunction after heart transplantation. During implantation of the pacemaker lead measurements were reported normal, atrial sensing was not documented because of sinus arrest. After implantation the patient complained about intermittent palpitations. Read More

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Arrhythmias in Patients with Implantable Devices.

Card Electrophysiol Clin 2019 06 4;11(2):363-373. Epub 2019 Apr 4.

Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri 57, Varese 21100, Italy.

Pacemakers, cardioverter/defibrillators, and implantable loop recorders with their continuously improved diagnostic capabilities offer detailed information that can help interpreting a cardiac arrhythmia in implanted patients. Nevertheless, in some cases, analysis of the electrical signals stored in the device memory may not be easy. An accurate knowledge of the company-specific software and the meaning of the different markers used are necessary to correctly interpret the arrhythmia or diagnose an inappropriate device intervention due to under- or oversensing. Read More

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Mapping and Ablation of Retrograde Conduction During a Nearly Incessant Pacemaker-mediated Tachycardia in a Patient with Third-degree Atrioventricular Block.

J Innov Card Rhythm Manag 2019 Apr 15;10(4):3620-3622. Epub 2019 Apr 15.

FateBeneFratelli Hospital, Naples, Italy.

Patients with third-degree atrioventricular block implanted with a dual-chamber pacemaker in DDD mode can develop pacemaker-mediated tachycardias if retrograde ventriculoatrial (VA) conduction is present. Programming a long post-VA refractory period to avoid tachycardia initiation can be contraindicated if these patients have a good atrial response from exercise testing and require a high maximum tracking rate to allow for a proper response to sensed atrial rhythms. We report a case of a patient in whom mapping and ablation of retrograde conduction during the pacemaker-mediated rhythm was the only solution to allow both the programming of a high tracking rate and the elimination of tachycardia induction. Read More

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Complete Atrioventricular Block with Intact Retrograde Conduction in Cardiac Rhythm Management Devices: Implications of the Phenomenon.

J Innov Card Rhythm Manag 2019 Apr 15;10(4):3617-3619. Epub 2019 Apr 15.

Abbott Laboratories, Chicago, IL, USA.

Intact retrograde ventriculoatrial (VA) conduction in the presence of complete atrioventricular (AV) heart block has been well-documented in the past. We sought to describe the prevalence and clinical significance of intact VA conduction accompanied by complete antegrade AV block in patients with implanted cardiac rhythm management (CRM) devices. During routine follow-up of CRM devices in our device clinic, 42 patients were found to be in a state of complete heart block. Read More

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Unexpected and undesired side-effects of pacing algorithms during exercise.

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

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October 2019

The limitations and potential adverse effects of the premature ventricular contraction response.

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

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October 2018

Pacemaker-mediated arrhythmias.

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

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October 2018

Pacemaker-mediated tachycardia: What is the mechanism?

Pacing Clin Electrophysiol 2018 11 19;41(11):1549-1551. Epub 2018 Sep 19.

First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland.

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November 2018

Pacemaker-mediated tachycardia in the absence of retrograde ventriculoatrial conduction: What is the mechanism?

J Cardiovasc Electrophysiol 2018 12 25;29(12):1721-1723. Epub 2018 Sep 25.

Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

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December 2018

Typical atrial flutter mimicking a pacemaker-mediated tachycardia.

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

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Pacemaker-mediated tachycardia with narrow QRS complexes.

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

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Pin-port misconnection induced endless loop tachycardia.

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.

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Ventriculoatrial synchrony induced heart failure.

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

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December 2018

Desynchronization in a cardiac resynchronization device induced by a pacemaker-mediated tachycardia algorithm.

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

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January 2018

Ventricular fibrillation triggered by a pacemaker-mediated tachycardia protection algorithm.

Europace 2017 Aug;19(8):1342

CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France.

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SafeR and escape junctional rhythm: A singular trigger for pacemaker-mediated tachycardia.

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

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Accuracy of the pacemaker-mediated tachycardia algorithm in Boston Scientific devices.

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

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November 2017

Validation of device algorithm to differentiate pacemaker-mediated tachycardia from tachycardia due to atrial tracking.

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

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