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Related Experiment Videos

DDD-pacemaker pseudomalfunction during supraventricular tachycardia.

J M Fontaine1, C Alma-Perri, N el-Sherif

  • 1State University of New York Health Science Center, New York.

Pacing and Clinical Electrophysiology : PACE
|October 1, 1988
PubMed
Summary
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Pacemakers can exhibit asynchronous pacing when detecting noise, like rapid heartbeats. This case shows how QRS complexes falling into the pacemaker

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Pacemaker asynchronous pacing is a protective feature against output inhibition from electromagnetic interference or other noise.
  • DDD pacemakers have a noise sampling period (NSP) within the ventricular refractory period to detect and respond to noise.

Observation:

  • A patient with a DDD pacemaker experienced asynchronous dual chamber pacing (noise reversion).
  • This occurred due to repetitive QRS complexes falling within the pacemaker's NSP during supraventricular tachycardia (SVT) at 215 bpm.
  • Detected QRS complexes post-refractory period were misinterpreted as premature ventricular depolarizations, extending the refractory period and triggering noise reversion.

Findings:

  • The mechanism involves QRS complexes detected during the NSP, leading to automatic refractory period extension.

Related Experiment Videos

  • Consecutive QRS complexes within the NSP caused recycling of the extended refractory period.
  • This resulted in forced asynchronous dual chamber pacing at the device's programmed lower rate.
  • Subthreshold esophageal pacing simulated SVT, successfully initiating the noise reversion response in the patient.

    • Implications:

    • Understanding this mechanism is crucial for managing pacemaker behavior during tachyarrhythmias.
    • This highlights potential interactions between intrinsic cardiac signals and pacemaker sensing algorithms.
    • Optimizing pacemaker programming may be necessary to prevent inappropriate noise reversion in certain clinical scenarios.