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Pacemaker-mediated polymorphic ventricular tachycardia

D S Goldman1, P A Levine

  • 1Division of Cardiology, University of Florida, Jacksonville, USA.

Pacing and Clinical Electrophysiology : PACE
|October 30, 1998
PubMed
Summary
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Pacemaker programming can inadvertently cause arrhythmias. Disabling a specific feature (+ PVARP on PVC) prevented recurrent polymorphic ventricular tachycardia (PMVT) in a patient with refractory bradycardia.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Polymorphic ventricular tachycardia (PMVT) is a serious arrhythmia often requiring intervention.
  • Permanent pacemaker implantation is a strategy for managing refractory bradycardia-dependent arrhythmias.
  • Pacemaker-mediated tachycardia (PMT) can be triggered by device programming.

Observation:

  • A patient with refractory bradycardia-dependent PMVT received a permanent pacemaker.
  • Despite pacemaker implantation, the patient experienced recurrent PMVT.
  • Device interrogation revealed a factory-programmed feature (+ PVARP on PVC) as the cause.

Findings:

  • The '+ PVARP on PVC' feature, intended to prevent PMT, induced cycle length variability.
  • This variability in cardiac cycle length precipitated recurrent PMVT episodes.

Related Experiment Videos

  • Deactivating the '+ PVARP on PVC' feature successfully resolved the arrhythmia.

    • Implications:

    • Standard pacemaker programming may require individual adjustment for certain arrhythmias.
    • Understanding device-feature interactions is crucial for preventing iatrogenic arrhythmias.
    • This case highlights the importance of thorough device interrogation and reprogramming in managing complex cardiac conditions.