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Inverted pacemaker mediated tachycardia induced during noninvasive electrophysiology testing
1Electrophysiology Laboratories, University of Connecticut Health Center, Farmington.
Pacing and Clinical Electrophysiology : PACE
|April 1, 1992
Summary
Pacemakers can cause unusual tachycardia during testing. Chest wall stimulation in AAT mode led to far-field R-wave sensing and a triggered atrial response, causing pacemaker-mediated tachycardia.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Pacemakers are crucial for cardiac rhythm management.
- Noninvasive electrophysiology testing aids in pacemaker function assessment.
- Pacemaker-mediated tachycardia (PMT) is a known complication.
Observation:
- A patient experienced an unusual PMT during noninvasive electrophysiology testing.
- The pacemaker was programmed in a unipolar, triggered pacing mode (AAT) with a short refractory period.
- Chest wall stimulation was employed for testing.
Findings:
- Far-field R-wave sensing occurred beyond the physiological atrial refractory period in the AAT mode.
- This sensing triggered an atrial response.
- The triggered response resulted in a single-chamber PMT.
Implications:
- This case highlights a rare mechanism of PMT.
- Understanding refractory periods and sensing is critical for safe pacemaker programming.
- Further research may refine testing protocols to prevent such events.