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Pacemaker syndrome with AAI rate variable pacing: importance of atrioventricular conduction properties, medication,
K den Dulk1, F W Lindemans, P Brugada
1Department of Cardiology, Academic Hospital Maastricht, University of Limburg, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|August 1, 1988
Summary
AAI Activitrax pacemakers can cause pacemaker syndrome due to medication interactions affecting AV conduction. Adjusting medication and pacemaker settings resolved these issues in a patient with sinus bradycardia.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Symptomatic sinus bradycardia often necessitates pacemaker implantation for rate control.
- AAI Activitrax rate-variable pacemakers offer sophisticated pacing modes but require careful parameter evaluation.
Observation:
- A patient experienced pacemaker syndrome during exercise, characterized by a prolonged atrioventricular (AV) conduction time.
- This was attributed to disopyramide prolonging the fast AV nodal pathway's refractory period, forcing conduction through the slow pathway.
Findings:
- Medication adjustment successfully resolved the pacemaker syndrome symptoms.
- Programming a bipolar electrode configuration prevented far-field QRS sensing, mitigating pacing interval resets.
Implications:
- AAI rate-variable pacing demands thorough assessment of AV conduction, intervals, and drug interactions.
- Multiprogrammable pacemakers with marker channels are crucial for diagnosing and managing anomalous pacing behaviors.
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