[Reevaluation of pacemaker-induced reentry tachycardias: incidence, mechanisms and therapy]

To reassess incidence, mechanisms and therapeutic possibilities in the treatment of pacemaker-induced reentry tachycardias (RT) in patients with the second generation of DDD-pacemakers, 35 consecutive patients were studied prospectively by measuring VA conduction at implant and searching for RT clinically and by repeat 24-hour ECG monitoring. Reprogramming to the VVI mode because of atrial flutter and to the AAI mode because of lead displacement was necessary in 2 and 1 of the patients respectively. RT were detected in 7/32 patients (22%), 4 of whom were symptomatic. The triggering mechanism of RT was premature ventricular contraction in 4 patients, premature atrial contractions in 1, loss of atrial sensing in 1, and remained unclear in 1. Unlike the 30% of patients of an earlier consecutive series with first generation of physiologic PM who had RT and required permanent reprogramming to VVI stimulation in 10% of cases, RT was abolished in all patients maintaining physiologic pacing by prolonging the atrial refractory period, shortening the av delay, adjusting atrial output or atrial sensing, or by antiarrhythmic therapy.