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Dual-demand pacing for refractory atrioventricular re-entry tachycardia
Pacing and Clinical Electrophysiology : PACE
|March 1, 1979
Summary
An automatic dual-demand pacemaker effectively treated refractory paroxysmal re-entry atrioventricular tachycardia in Wolff-Parkinson-White syndrome for some patients. However, lead placement and tachycardia rate influenced pacemaker reliability, necessitating alternative treatments in cases of failure.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Refractory paroxysmal re-entry atrioventricular tachycardia in Wolff-Parkinson-White syndrome poses a treatment challenge.
- Automatic dual-demand pacemakers offer a potential therapeutic option for managing these arrhythmias.
Observation:
- Six patients with Wolff-Parkinson-White syndrome and refractory tachycardia were evaluated using an automatic dual-demand pacemaker.
- Pacemaker function was assessed with electrodes placed in the coronary sinus or on the ventricular epicardium.
- Adjunctive oral medications like verapamil or propranolol were administered to enhance pacemaker efficacy and prevent inappropriate activation.
Findings:
- The pacemaker system demonstrated complete effectiveness in three patients over 11–47 months.
- Two patients experienced unreliable sensing due to lead issues (coronary sinus and left ventricular).
- One patient's pacemaker was ineffective when tachycardia rates exceeded 170 bpm, particularly in upright positions.
Implications:
- Pacemaker therapy can be effective for specific cases of drug-refractory atrioventricular tachycardia in Wolff-Parkinson-White syndrome.
- Lead integrity and the maximum achievable tachycardia rate are critical factors for successful pacemaker management.
- Pacemaker failure necessitates alternative treatments such as cryosurgical ablation or amiodarone therapy.