Related Experiment Video
Updated: Dec 13, 2025
08:05
Optimization of Transesophageal Atrial Pacing to Assess Atrial Fibrillation Susceptibility in Mice
Published on: June 29, 2022
3.3K
Is competitive atrial pacing a possible trigger for atrial fibrillation? Observations from the RATE registry.
Michael V Orlov1, Brian Olshansky2, David G Benditt3
1Department of Medicine, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
Heart Rhythm
|August 2, 2020
Summary
Device-triggered atrial tachycardia and atrial fibrillation (AT/AF) from competitive atrial pacing (CAP) is common in patients with cardiac implantable electronic devices (CIEDs). This device-triggered AT/AF differs from spontaneous AT/AF in duration and morphology.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Asymptomatic atrial tachycardia and atrial fibrillation (AT/AF) are frequently detected in patients with cardiac implantable electronic devices (CIEDs).
- The clinical significance of device-detected AT/AF, particularly episodes triggered by competitive atrial pacing (CAP), remains uncertain.
Purpose of the Study:
- To investigate and characterize the association between CAP and AT/AF.
- To analyze the largest series of observations to date regarding CAP-triggered AT/AF.
Main Methods:
- Analysis of electrograms (EGMs) from 1352 patients within the RATE multicenter registry (5379 patients total) with CIEDs.
- Experienced adjudicators assessed the causal relationship between AT/AF and CAP onset, duration, and morphology in 1352 patients.
Main Results:
- A strong association was found between CAP and AT/AF (P ≤ .02) in 225 patients with 1394 episodes.
- In 62% of episodes, CAP was concluded to trigger AT/AF.
- CAP-triggered AT/AF episodes exhibited variable EGM morphology and shorter cycle lengths compared to spontaneous AT/AF.
Conclusions:
- Device-triggered AT/AF due to CAP is more prevalent than previously thought.
- Device-triggered AT/AF is distinct from spontaneous AT/AF in terms of duration and morphology.
- The clinical implications of device-triggered AT/AF may differ from those of spontaneous AT/AF.
Related Concept Videos
01:29Disturbances in Heart Rhythm
2.2K
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
2.2K
01:29Dysrhythmias III: Characteristics of Dysrhythmias
291
Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
291
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
330
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
330
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
359
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
359
01:28Dysrhythmias II: Classification of Tachyarrhythmias
364
Tachyarrhythmias are a type of dysrhythmia where the heart rate exceeds 100 beats per minute. Here are some common types of tachyarrhythmias:Sinus TachycardiaSinus tachycardia originates from increased impulses from the sinus node, leading to an elevated heart rate. It is often triggered by stress, fever, or exercise.Patients may experience palpitations, a sensation of a racing heart, dizziness, and chest discomfort.Causes and Risk Factors: Common causes include physical exertion, emotional...
364
01:25Dysrhythmias VI: Management of Dysrhythmias
274
Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
274