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'Pacemaker-Mediated Tachycardia' (150)


Jan
2018

This report describes the occurrence of desynchronization in a patient with a cardiac resynchronization device programmed with an active pacemaker-mediated tachycardia algorithm based on AV delay modification. Desynchronization was precipitated by sinus tachycardia and the abrupt return of the prevailing AV delay that followed the periodic prolongation of the AV delay mandated by activity of the algorithm. Prevention of desynchronization in this setting requires programming a right ventricular upper rate interval longer than the sum of the programmed ventriculoatrial interval and the AV delay.

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Aug
2017

A 70-year-old man, who previously received a dual chamber pacemaker for paroxysmal AV block (Sorin Symphony DR 2550), was noted on telemetry to have multiple episodes of rapid ventricular pacing at approximately 120bpm. Evaluation of the telemetry strips revealed that all of the rapid ventricular pacing episodes were initiated by brief runs of escape junctional rhythm. Programmed bradycardia parameters were AAI SafeR with lower rate limit of 50bpm.

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Aug
2017

The incidence of pacemaker-mediated tachycardia (PMT) varies as a function of patient characteristics, device programming and algorithm specificities. We investigated the efficacy of the Boston Scientific algorithm by reviewing PMT episodes in a large device population.
In this multicenter study, we included 328 patients implanted with a Boston Scientific device: 157 non-dependent patients with RYTHMIQ™ activated (RYTHMIQ group), 76 patients with permanent AV-conduction disorder (AV-block group) and 95 Cardiac Resynchronization Therapy patients (CRT group).

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Dec
1969

Current cardiac devices cannot always differentiate between pacemaker-mediated tachycardia (PMT) and tracking of sinus or atrial tachycardia. We previously derived a novel algorithm for distinguishing the 2 mechanisms based on the specific termination response to postventricular atrial refractory period extension, atrial rates, and changes in atrial electrogram morphology.
The purpose of this study was to evaluate how this algorithm would have performed in a clinical setting based on previously recorded PMT events.

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Dec
1969

Similar to endless loop tachycardia (ELT), repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) is a ventriculoatrial (VA) synchrony pacemaker-mediated arrhythmia. RNRVAS was first described in 1990 and can only occur in the presence of retrograde VA conduction and dual-chamber or cardiac resynchronization devices with tracking (P-synchronous ventricular pacing such as DDD, DDDR) or nontracking pacing modes that allow AV-sequential pacing (DDI, DDIR). RNRVAS is promoted by (1) high lower rate limit or any feature that allows rapid pacing, (2) long AV intervals, or (3) long postventricular atrial refractory period (PVARP).

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Dec
1969

A 59-year-old woman with a history of congestive heart failure, who previously received a biventricular cardioverter-defibrillator was admitted with dyspnea and peripheral edema. She was noted on telemetry to have multiple self-terminated episodes of rapid ventricular pacing, consistent with pacemaker-mediated tachycardia. All episodes started after three consecutive ventricular extrasystoles.

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Dec
1969

In Boston Scientific dual-chamber devices, the RYTHMIQ algorithm aims to minimize right ventricular pacing.
We evaluated the performance of this algorithm determining (1) the appropriateness of the switch from the AAI(R) mode with backup VVI pacing to the DDD(R) mode in case of suspected loss of atrioventricular (AV) conduction and (2) the rate of recorded pacemaker-mediated tachycardia (PMT) when AV hysteresis searches for restored AV conduction.
In this multicenter study, we included 157 patients with a Boston Scientific dual-chamber device (40 pacemakers and 117 implantable cardioverter-defibrillators) without permanent AV conduction disorder and with the RYTHMIQ algorithm activated.

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Dec
2015

Pacemaker-mediated tachycardia (PMT) is the term used to describe a repetitive sequence of sensed retrograde P waves followed by ventricular pacing at or below the maximum tracking rate. The following events can promote atrioventricular (AV) dissociation, retrograde conduction, and the onset of PMT: ventricular or atrial extrasystole, an excessively long programmed AV delay, external interference or myopotentials sensed by the atrial channel, atrial sensing or pacing failure, the absence of postventricular atrial refractory period extension after removal of a magnet, and VDD pacing at a higher rate than sinus rate. In contemporary devices, each manufacturer has a proprietary algorithm to detect and terminate PMT.

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Dec
1969

An 81-year-old woman who had undergone dual chamber pacemaker implantation for sick sinus syndrome was referred to our hospital with drug-refractory common atrioventricular (AV) nodal reentrant tachycardia. Ventricular pacing (Vp) following premature atrial contraction (PAC) with a long AV interval induced ventriculoatrial (VA) conduction, which allowed the tachycardia to be initiated. The sensed AV interval was shortened to 80 ms, allowing Vp during the refractory period of VA conduction.

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Sep
2015

Intermittent Irregular Pacemaker-Mediated Tachycardia.

Pacing Clin Electrophysiol 2015 Sep 5;38(9):1117-20. Epub 2015 Feb 5.
Mark Gilmore, Sern Lim

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May
2015


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May
2014

Newer algorithms in bradycardia management.

Cardiol Clin 2014 May 15;32(2):283-92. Epub 2014 Feb 15.
Daniel Sohinki, Owen A Obel
Permanent cardiac pacemakers (PPM) are effective in the treatment of bradycardia in a growing number of clinical scenarios. An appreciation of the capacity of PPMs to result in negative hemodynamic and proarrhythmic effects has grown alongside clinical experience with permanent pacing. Such experience has necessitated the development of algorithms aimed at optimizing device functionality across a broad spectrum of physiologic and pathologic conditions.

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Jan
2014

An uncommon cause of pacemaker-mediated ventricular tachycardia.

J Cardiovasc Electrophysiol 2014 Jan 17;25(1):107-9. Epub 2013 Sep 17.
Daniel P Morin

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Apr
2014

[Wide QRS tachycardia preceded by pacemaker spikes].

Semergen 2014 Apr 13;40(3):e57-9. Epub 2013 Jun 13.
M Romero, A Aranda, F J Gómez, A Jurado
The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker.

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Jan
2014

When a search causes back-firing.

Pacing Clin Electrophysiol 2014 Jan 21;37(1):109-12. Epub 2013 May 21.
Fong T Leong, Andrew S Penney

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Oct
2013

Ventriculoatrial (VA) conduction and related pacemaker-mediated tachyarrhythmias (PMT) have not been systematically investigated in a large cohort of patients implanted for symptomatic atrioventricular (AV) block.
Two hundred fifty consecutive patients (71±14 years, 63% male) implanted for symptomatic second- or third-degree AV block were screened for retrograde VA conduction and related PMTs including endless loop tachycardia (ELT) and repetitive nonreentrant VA synchrony (RNRVAS). After a mean post-implantation period of 38±12 months, AV block was persistent in 137 (55%) and variable in 113 (45%) patients.

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Feb
2013

Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator.

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Jan
2013


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Jul
2012

This report describes the de novo occurrence of pacemaker-mediated tachycardia (PMT) in a patient with a dual-chamber implantable cardioverter-defibrillator and stable retrograde ventriculoatrial conduction time. The same rate-adaptive post-ventricular atrial refractory period (PVARP) duration had previously prevented PMT. Oversensing of atrial false signals from a defective lead shortened the PVARP with consequent sensing of retrograde conduction.

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Jul
2012

We report the initiation of pacemaker-mediated tachycardia by a St Jude implantable cardioverter-defibrillator with a programmed Ventricular Intrinsic Preference algorithm used for minimizing or inhibiting right ventricular pacing. This feature prolongs the atrioventricular (AV) delay periodically to determine if ventricular sensed events follow atrial events. Retrograde ventriculoatrial conduction and pacemaker-mediated tachycardia were initiated by long extended AV delays of 300 and 400 milliseconds.

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Apr
2012

Pacemaker-mediated tachycardia (PMT) remains a clinical problem in patients with dual-chamber pacemaker despite technological advances. The onset mechanism of this tachycardia is sensing of retrograde atrial activation after ventricular stimulation. Repeated retrograde conduction perpetuates tachycardia.

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Apr
2012

The number of patients receiving pacemakers and defibrillators has grown substantially over the last 20 years. In addition, the complexity and sophistication of these devices have increased, making diagnosis of pacemaker problems using the electrocardiogram (ECG) more difficult for clinicians in the emergency department. This article will focus on a few of the pitfalls to be avoided when interpreting paced ECGs.

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Aug
2011

Dual-chamber pacemaker systems can lead to two forms of pacemaker-facilitated tachycardia: pacemaker-mediated tachycardia (PMT) and tracking of sinus or atrial tachycardia. Current pacemaker algorithms cannot always differentiate between these two tachycardias.
The purpose of this study was to investigate a novel algorithm for distinguishing the two mechanisms of pacemaker-facilitated tachycardia, which is based on the specific termination response to postventricular atrial refractory period (PVARP) extension.

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Nov
2010

The case of a patient with a unipolar VVIR, who developed a sensor-driven increased pacing rate at rest following pulse generator replacement, is presented. The cause was pectoral muscle stimulation, which triggered a sensor-driven rate response in the supine position. The possible causes and management are discussed.

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May
2011

Atypical initiation of endless-loop, pacemaker-mediated tachycardia.

Pacing Clin Electrophysiol 2011 May 14;34(5):617-20. Epub 2010 Oct 14.
Sanjoy Bhattacharya, Norman C Wang

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Jul
2010

Pacemaker-mediated tachycardia.

Heart 2010 Jul 28;96(13):1062. Epub 2010 May 28.
W Ullah, A Stewart

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May
2010

Repetitive Nonreentrant Ventriculoatrial Synchrony (RNRVAS).

Indian Pacing Electrophysiol J 2010 May 5;10(5):203-4. Epub 2010 May 5.
Johnson Francis

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Sep
2009

A 74-year-old man with a dual-chamber implantable cardioverter defibrillator implanted 3 years before experienced multiple ventricular tachycardias (VTs). All episodes were initiated by pacemaker-mediated tachycardia (PMT) that was either stopped by atrial undersensing or the tachycardia termination algorithm of the device. After the termination of PMT, two rapid ventricular paced beats, the first initiated by artificial triggering and the second due to retrograde conduction of the first one, initiated VT that was successfully terminated by antitachycardia pacing or a direct current shock of the device.

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Oct
2009

As new algorithms are being developed to promote intrinsic atrioventricular conduction in preventing the deleterious effects of right ventricular pacing, more complex rhythm strips can be encountered. In our patient with a dual-chamber implantable cardioverter-defibrillator, such an algorithm resulted in a pacemaker-mediated tachycardia with several changes in cycle length.

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Oct
2008

The diagnostic programmes of modern pacemakers have increased our knowledge of atrial tachyarrhythmias (ATAs) in chronically paced patients. These programmes also support the evaluation of the effects of pharmacological treatment of ATAs. The success of interruption and/or prevention of ATAs with pacemakers depends strongly on the diagnostic accuracy and the properties of the pacing algorithms, their individual programming and the site and configuration of the pacing leads.

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Oct
2008

Pacemaker-mediated tachycardia (PMT) is an arrhythmia seen in patients implanted with dual-chamber pacemakers. It occurs when ventricular contraction is followed by retrograde conduction to the atrium, which is sensed by the pacemaker, leading to ventricular triggering. A vicious re-entry cycle is set up, leading to incessant tachycardia unless appropriately terminated.

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Dec
2007

Etomidate unlikely to have induced pacemaker-mediated tachycardia.

Anesthesiology 2007 Dec;107(6):1036; author reply 1037
Marc A Rozner

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Apr
2007

The first part of this two-part review discussed the indications for various types of epicardial pacing systems and an overview of the routine care of a pacemaker-dependent patient. Dual chamber temporary pulse generators now feature many of the refinements developed initially for use in permanent pacemakers. Few of these are utilised in the immediate postoperative period, often solely due to lack of familiarity with all but basic functions.

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Feb
2007

In the last ten years the technology in Electrophysiology and Cardiac Parcing has advanced rapidly until the arrive of the implantable cardioverter defibrillator for the prevention of Sudden Death and also to the three chamber pacing for ventricular resinchronization as a treatment for advanced heart failure. In the middle of these we have dual chamber pacemakers. The increasing expectative of life worldwide gives the need and more frequency of implanting dual chamber pacemakers with the exception of the patient with chronic atrial fibrillation.

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Feb
2007

Within the United States, the elderly population is projected to increase 126% by 2050, making those over the age of 65 the most rapidly growing segment in the population. Permanent pacemakers and defibrillators are important therapies with expanding indications for their use, and older persons constitute the majority of recipients of these devices. Recognizing complications associated with these cardiac devices is essential in caring for patients with them.

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Nov
2005

It has been shown that a tachycardia can facilitate the induction of the same ("atrial fibrillation begets atrial fibrillation") or a different tachycardia. This may also apply for pacemaker-mediated tachycardia as the present case documents.

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Jul
2005

Pacemaker diagnostic counters are used to guide device programming and patient management. However, these data are susceptible to inappropriate classification of events. The aim of this multicenter study was to evaluate pacemaker diagnostic data using stored intracardiac electrograms (EGMs).

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