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Spontaneous endless loop tachycardia.

D Oseran, K Ausubel, P T Klementowicz

    Pacing and Clinical Electrophysiology : PACE
    |May 1, 1986
    PubMed
    Summary
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    Pacemaker-mediated endless loop tachycardia can occur with normally timed P waves. Shortening the atrial refractory interval after ventricular pacing effectively terminated these tachycardias.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Medical Devices

    Background:

    • Pacemaker-mediated endless loop tachycardia (PMELT) typically arises from P waves occurring during atrial channel sensitivity post-QRS.
    • This mechanism involves retrograde atrial activation following ventricular depolarization.

    Observation:

    • This study details five cases of PMELT initiated by normally timed P waves.
    • These P waves were either spontaneous before ventricular pacing or triggered by atrial pacing followed by ventricular pacing and QRS complex.

    Findings:

    • In all observed cases, the atrial refractory interval (ARI) was shorter than the retrograde conduction time.
    • Prolonging the ARI post-ventricular event terminated the tachycardia in four cases.

    Implications:

    Related Experiment Videos

    • These findings suggest a novel mechanism for PMELT initiation.
    • Adjusting the ARI is a viable strategy for managing these specific pacemaker-induced arrhythmias.
    • In challenging cases, programming to ventricular inhibited mode may be necessary.