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Related Experiment Videos

"Pseudo-endless loop" tachycardia in an AV universal (DDD) pacemaker.

S Amikam, C Andrews, S Furman

    Pacing and Clinical Electrophysiology : PACE
    |January 1, 1984
    PubMed
    Summary
    This summary is machine-generated.

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    A ventricular arrhythmia mimicking endless loop tachycardia occurred in a patient with a DDD pacemaker. The event was caused by pacemaker programming and ventricular premature contractions, not retrograde conduction.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Medical Devices

    Background:

    • Atrioventricular (AV) universal (DDD) pacemakers are used to manage bradyarrhythmias.
    • Endless loop tachycardia (ELT) is a specific type of supraventricular tachycardia that can be sustained by pacemaker function.
    • Ventricular premature contractions (VPCs) can sometimes trigger arrhythmias in patients with pacemakers.

    Observation:

    • A 3-beat episode of ventricular arrhythmia was observed in a patient with a DDD pacemaker.
    • The arrhythmia presented with characteristics similar to ELT, including onset after a VPC, rapid rate, and loss of P waves.
    • Retrograde conduction, a prerequisite for ELT, was absent during the episode.

    Findings:

    • The observed arrhythmia was not true ELT due to the lack of retrograde conduction.

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  • The mechanism involved interference from a VPC disrupting the paced QRS sequence.
  • Pacemaker programming, specifically the upper rate limit and programmed AV delay, contributed to the arrhythmia's manifestation and termination.

    • Implications:

    • This case highlights a potential pacemaker-mediated arrhythmia distinct from classic ELT.
    • Understanding these mechanisms is crucial for accurate diagnosis and programming of pacemakers.
    • Clinicians should consider pacemaker-device interactions when evaluating arrhythmias in patients with pacemakers.