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Hyperkalemia induced pacemaker far-field endless loop tachycardia.

S S Barold1

  • 1Genesee Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. ssbarold@aol.com

Pacing and Clinical Electrophysiology : PACE
|October 5, 2001
PubMed
Summary
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Hyperkalemia can trigger a dangerous heart rhythm called endless loop tachycardia in severe heart disease patients. This occurs when slow ventricular activation is misinterpreted by the atrial channel, causing a sustained abnormal heart rhythm.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Endless loop tachycardia (ELT) is a type of supraventricular tachycardia.
  • Severe heart disease can predispose patients to complex arrhythmias.
  • Hyperkalemia is a known risk factor for cardiac electrical disturbances.

Observation:

  • A patient with severe heart disease developed an unusual tachycardia.
  • The tachycardia was induced by a state of hyperkalemia.
  • Prolonged ventricular activation was noted during the event.

Findings:

  • The prolonged ventricular activation resulted in a far-field ventricular signal.
  • This far-field signal was sensed by the atrial channel.
  • The sensing occurred beyond the postventricular atrial refractory period, initiating ELT.

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Implications:

  • Hyperkalemia should be considered in patients with severe heart disease presenting with unexplained tachycardias.
  • Understanding the electrophysiological mechanisms of ELT is crucial for management.
  • This case highlights the potential for metabolic disturbances to unmask or induce complex arrhythmias.