Artificial Circus Movement Tachycardias: Incidence, Mechanisms, and Prevention

Abstract

In a group of 45 patients treated with Medtronic 7000 and 7100 pulse generators for sick sinus syndrome or second or third degree atrioventricular block, an atrial synchronous mode of pacing was programmed in 34 cases and spontaneously occurring artificial circus movement tachycardias (ACMTs) were observed in nine. An analysis of conditions of occurrence, triggering mechanisms and patterns of ACMT, is presented. Various modalities of prevention are discussed. They resulted in suppression of ACMT in five patients and decrease of incidence in a sixth; the three remaining subjects were managed by definitive reprogramming in the DVI mode. Our conclusion is that correct prevention of ACMT requires the use of dual chamber pulse generators with programmable atrial refractory periods. For patients in whom a unit has already been implanted, careful observation of the triggering mechanism and pattern of ACMT may help in determining the most suitable way to prevent and suppress the arrhythmia.

Pulsed Doppler Verification of Atrial Contribution to Ventricular Filling in Sequential Pacing

“…3); when there is no atrial capture, retrograde P waves may be present (Figs. 4,5). If favorable conditions are present, pacemaker-mediated tachycardia may occur.^ In any case, the evidence of atrial electrical activity fol-lowing the pacing spike does not give adequate information on the effectiveness of atrial mechanics.…”

Arrhythmias in the Coronary Care Unit

“…Pacemaker-mediated tachycardia (PMT) is a well-known complication of dual chamber pacing systems. 46,47 The PMT usually begins with a premature ventricular complex with retrograde ventriculoatrial (VA) conduction; the retrograde P wave is sensed in the atrial channel, triggering a ventricular output that once again causes retrograde VA conduction, thus creating an ''endless loop'' (Figure 8). The initiating mechanism of PMT is almost always AV dissociation, created by a ventricular extrasystole, loss of atrial capture, or oversensing in the atrial channel.…”