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Related Experiment Videos

Orthodromic pacemaker circus movement tachycardia.

P den Heijer, H J Crijns, E J Van Binsbergen

    Pacing and Clinical Electrophysiology : PACE
    |July 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

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    A patient with sick sinus syndrome experienced a rare pacemaker-mediated tachycardia (PCMT) triggered by a novel atrial stimulation feature. This case highlights conditions leading to PCMT and suggests preventive strategies.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Medical Device Technology

    Background:

    • Sick sinus syndrome (SSS) is a common indication for pacemaker implantation.
    • Pacemaker-mediated tachycardia (PCMT) is a known complication of pacemaker use.
    • DDD (AV universal) pacemakers offer advanced pacing capabilities but can be associated with specific tachyarrhythmias.

    Observation:

    • A 33-year-old woman with SSS developed an orthodromic PCMT with antegrade atrioventricular (AV) conduction and a retrograde pathway.
    • The PCMT was provoked and sustained by premature ventricular contraction-synchronous atrial stimulation (PVC-SAS), a feature designed to prevent antidromic PCMTs.
    • The tachycardia occurred under specific conditions: PVC-SAS, atrial undersensing, and first-degree AV block.

    Findings:

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  • This case demonstrates a novel mechanism of PCMT induced by PVC-SAS in a patient with SSS.
  • The interplay of PVC-SAS, atrial undersensing, and AV block created the electrophysiological conditions for the sustained tachycardia.
  • The findings challenge the typical understanding of PVC-SAS as solely a preventive measure.

    • Implications:

    • Understanding these specific conditions is crucial for preventing pacemaker-related tachycardias.
    • Clinicians should be aware of the potential for PCMT even with advanced pacemaker features like PVC-SAS.
    • Recommendations for preventing this specific type of PCMT are provided, aiding in patient management and device programming.