Pacemaker lead-related macroreentrant atrial tachycardia
Frederico Scuotto1, Maria Cecilia Xavier Souto1, Claudio Cirenza1
1Federal University of Sao Paulo, SP, Brazil.
Indian Pacing and Electrophysiology Journal
|May 22, 2022
Summary
Pacemaker leads can cause scar tissue, leading to macroreentrant atrial tachycardia (MAT). Radiofrequency ablation successfully treated this rare arrhythmia in a patient with an old ventricular pacemaker lead.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Macroreentrant atrial circuits are often linked to myocardial scarring.
- Scar tissue adjacent to pacemaker (PM) leads has been previously documented.
- However, PM lead-associated reentrant tachycardias are infrequently reported.
Observation:
- A 63-year-old woman presented with macroreentrant atrial tachycardia (MAT).
- The tachycardia was related to the atrial path of a long-standing single-lead ventricular PM.
- Electrophysiological study excluded typical atrial flutter, confirming MAT diagnosis.
Findings:
- The MAT originated around the PM lead's trajectory, likely due to adjacent scar tissue.
- Experimental data supports the development of interstitial atrial fibrosis near ventricular leads.
- This suggests a potential mechanism for MAT in patients with such leads.
Implications:
- Recognizing PM lead-associated MAT is crucial for effective arrhythmia management.
- Safe radiofrequency ablation can be performed while preserving PM lead integrity.
- This case highlights a specific condition where MAT may develop due to pacemaker lead presence.
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