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Desynchronization in a cardiac resynchronization device induced by a pacemaker-mediated tachycardia algorithm.

S Serge Barold1, Nigel Lever2, Fiona Riddell2

  • 1Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.

Indian Pacing and Electrophysiology Journal
|January 9, 2018
PubMed
Summary

Pacemaker-mediated tachycardia algorithms can cause cardiac desynchronization. Adjusting the right ventricular upper rate interval prevents this by managing the atrioventricular delay during sinus tachycardia.

Keywords:
Cardiac arrhythmiaCardiac desynchronizationCardiac pacingCardiac resynchronizationPacemaker–mediated tachycardia

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Cardiac resynchronization therapy (CRT) devices improve heart function.
  • Pacemaker-mediated tachycardia (PMT) algorithms aim to prevent arrhythmias.
  • AV delay modification is a strategy used in some PMT algorithms.

Purpose of the Study:

  • To describe a case of cardiac desynchronization.
  • To identify the mechanism of desynchronization in a patient with a specific PMT algorithm.
  • To propose a method for preventing desynchronization in this scenario.

Main Methods:

  • Case report of a patient with a cardiac resynchronization device.
  • Analysis of device programming, including AV delay modification and PMT algorithm.
  • Evaluation of electrophysiological events during sinus tachycardia.

Main Results:

  • Desynchronization occurred due to the interaction between sinus tachycardia and the PMT algorithm's AV delay changes.
  • The algorithm's periodic AV delay prolongation was followed by an abrupt return to the baseline AV delay.
  • This abrupt change precipitated desynchronization.

Conclusions:

  • Programming the right ventricular upper rate interval is crucial for preventing desynchronization.
  • The right ventricular upper rate interval should exceed the sum of the ventriculoatrial interval and the AV delay.
  • This programming adjustment ensures stable cardiac function during PMT algorithm activity.