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Rate-Responsive Pacing Mimicking Ventricular Tachycardia.
1Division of Cardiology, Department of Veterans Affairs Medical Center, 10 North Greene Street, Baltimore, MD, 21201, USA.
The Journal of Invasive Cardiology
|June 1, 1996
Summary
Rate-responsive pacemakers can cause upper rate pacing at rest due to chest physiotherapy or muscle fasciculations. This inappropriate pacing was misdiagnosed as ventricular tachycardia in two patients but resolved after pacemaker reprogramming.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Rate-responsive pacemakers adjust pacing rate based on physiological demand.
- Upper rate pacing is a designed feature to meet increased metabolic needs.
- Inappropriate upper rate pacing can occur under non-physiological conditions.
Purpose of the Study:
- To report two cases of inappropriate upper rate pacing in patients with permanent ventricular pacemakers.
- To highlight the potential misdiagnosis of this pacing behavior as ventricular tachycardia.
- To demonstrate the effectiveness of pacemaker reprogramming in resolving this issue.
Main Methods:
- Case report of two patients with permanent ventricular pacemakers.
- Observation of upper rate pacing occurring at rest during specific activities (chest physiotherapy, muscle fasciculations).
- Review of pacemaker diagnostics and reprogramming procedures.
Main Results:
- Both patients experienced upper rate pacing while at rest, triggered by external stimuli or muscle activity.
- The rapid paced rhythm was initially misinterpreted as ventricular tachycardia in both instances.
- Reprogramming the pacemakers successfully eliminated the inappropriate rapid pacing episodes.
Conclusions:
- Upper rate pacing in response to non-cardiac stimuli can mimic ventricular tachycardia.
- Careful evaluation of pacemaker function is crucial in patients presenting with rapid rhythms.
- Pacemaker reprogramming is an effective solution for managing inappropriate upper rate pacing.