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Related Concept Videos

Mechanism of Cardiac Arrhythmias01:28

Mechanism of Cardiac Arrhythmias

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Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
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Electrophysiology of Normal Cardiac Rhythm01:19

Electrophysiology of Normal Cardiac Rhythm

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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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Disturbances in Heart Rhythm01:28

Disturbances in Heart Rhythm

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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...
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Conduction System of the Heart01:19

Conduction System of the Heart

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Autorhythmicity is a term that refers to the heart's inherent ability to generate electrical signals and instigate muscle contractions. This self-regulating conduction system within the heart consists of two key components: the pacemaker cells and specialized conducting cells.
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Pulse rhythm01:30

Pulse rhythm

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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
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Cardiac Action Potential01:30

Cardiac Action Potential

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Cardiac action potentials are essential for proper heart function, enabling the rhythmic contractions needed for adequate blood circulation. Nodal cells and Purkinje fibers, specialized for electrical conduction, generate these action potentials.
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
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Related Experiment Video

Updated: Jun 23, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Pacemaker-mediated reentrant arrhythmia facilitated by an atrial-tracking leadless pacemaker.

Dejan Vrtikapa1, Luke Chong1,2, Daniel Modaff1

  • 1Department of Medicine, Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Journal of Cardiovascular Electrophysiology
|June 26, 2024
PubMed
Summary

Pacemaker-mediated reentrant arrhythmia (PMRA) can occur with leadless pacemakers, even in patients with intact conduction. This underrecognized arrhythmia warrants further investigation for effective interventions.

Keywords:
AV synchronous leadless pacemakercomplete heart blockleadless pacemakerpacemaker arrhythmiapacemaker malfunction

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Pacemaker-mediated tachycardia (PMT) is a known complication in patients with dual-chamber pacemakers and intact ventriculoatrial (VA) conduction.
  • This case report details a pacemaker-mediated reentrant arrhythmia (PMRA) in a patient with an atrioventricular (AV) synchronous leadless pacemaker.

Observation:

  • A 91-year-old female with 2:1 AV conduction received an AV synchronous leadless pacemaker.
  • The patient exhibited atrial mechanical sense-ventricular paced beats frequently and developed a new cardiomyopathy.
  • Electrocardiogram revealed ventricular pacing with a short RP interval and superiorly directed P waves, indicating retrograde conduction.

Findings:

  • The leadless pacemaker led to near incessant PMRA, likely triggered by retrograde P waves from ventricular pacing.
  • Changes in ventricular pacing rate directly influenced atrial rate, suggesting a reentrant circuit.
  • The arrhythmia was associated with sinoatrial node dysfunction and intact VA conduction.

Implications:

  • PMRA may be underrecognized in patients with AV synchronous leadless pacemakers due to its potentially lower rates.
  • This case highlights the need for increased awareness and further research into the interventions and clinical implications of PMRA in this population.
  • Understanding PMRA mechanisms is crucial for optimizing leadless pacemaker therapy and patient outcomes.