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Termination of pacemaker-mediated tachycardia by adenosine
J B Conti1, A B Curtis, J A Hill
1University of Florida College of Medicine, Division of Cardiology, Gainesville 32610-0277.
Clinical Cardiology
|January 1, 1994
Summary
This case study shows adenosine can stop pacemaker-mediated tachycardia (PMT) by blocking signals between heart chambers. Reprogramming the pacemaker also prevented further PMT episodes in a heart transplant patient.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Cardiac transplantation patients may require pacemakers for bradycardia.
- Pacemaker-mediated tachycardia (PMT) is a potential complication of pacemaker use.
Observation:
- A 30-year-old heart transplant recipient experienced pacemaker-mediated tachycardia during cardiac catheterization.
- The tachycardia presented as rapid ventricular pacing with capture.
- Intravenous adenosine administration successfully terminated the episode.
Findings:
- Adenosine effectively broke the pacemaker-mediated tachycardia by inducing ventriculoatrial block.
- Reprogramming the pacemaker to specific AV delay and postventricular atrial refractory periods resolved the issue.
- This demonstrates adenosine's utility in acute PMT management.
Implications:
- Intravenous adenosine is a viable option for terminating pacemaker-mediated tachycardia.
- Pacemaker reprogramming is crucial for long-term prevention of PMT.
- Understanding PMT mechanisms is vital for managing cardiac transplant patients with pacemakers.