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Tachycardia mediated by an AV universal (DDD) pacemaker triggered by a ventricular depolarization
Pacing and Clinical Electrophysiology : PACE
|January 1, 1986
Summary
Pacemaker-mediated tachycardia occurred in a Chagas disease patient due to atrial lead misplacement. This abnormal sensing caused the tachycardia, requiring careful device placement and monitoring.
Area of Science:
- Cardiology
- Electrophysiology
- Infectious Diseases
Background:
- Chagas' disease can cause cardiac conduction abnormalities, including right bundle branch block and ventricular arrhythmias.
- A 44-year-old female patient with Chagas' disease presented with these cardiac conditions.
Observation:
- Invasive evaluation revealed a prolonged HV interval (100 ms), indicating significant conduction delay.
- A Medtronic Versatrax 7000 pacemaker was implanted.
- Following implantation, the patient developed pacemaker-mediated tachycardia (PMT).
Findings:
- Esophageal lead placement excluded atrial-triggered tachycardia.
- The PMT was diagnosed as resulting from abnormal sensing of ventricular depolarization.
- This was attributed to the atrial lead being malpositioned in the right ventricular outflow tract.
Implications:
- Accurate atrial lead placement is crucial for preventing PMT in pacemaker patients.
- This case highlights the importance of considering lead position in diagnosing PMT, especially in patients with underlying cardiac conditions like Chagas' disease.
- Proper pacemaker programming and lead management are essential for optimal patient outcomes.