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Programming a long paced atrioventricular interval may be risky in DDDR pacing
M G Pieterse1, K den Dulk, B M van Gelder
1Department of Cardiology, Academic Hospital Maastricht, University of Limburg, Maastricht, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|February 1, 1994
Summary
Programming a long paced AV interval in DDDR pacemakers can lead to T wave pacing. This occurs when the pacemaker fails to sense conducted QRS complexes, potentially causing adverse effects during exercise.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Dual chamber pacemakers (DDDR) are used for intermittent atrioventricular (AV) block.
- Long paced AV intervals (≥200 msec) can prolong generator life and improve hemodynamics.
- Programming considerations are crucial for patient safety and device function.
Observation:
- A case report details a patient with intermittent AV block and a DDDR pacemaker.
- The patient experienced frequent T wave pacing with ventricular capture during exercise.
- This occurred with a programmed paced AV interval of 200 msec.
Findings:
- T wave pacing resulted from the pacemaker failing to sense conducted QRS complexes.
- Sensing failure was linked to the ventricular blanking period following atrial stimulus delivery.
- Apparent P wave undersensing initiated the T wave pacing events.
Implications:
- Long paced AV intervals in DDDR pacemakers carry potential risks.
- Careful programming is necessary to avoid T wave pacing and ensure appropriate sensing.
- Clinical evaluation protocols should consider these potential adverse events during exercise testing.