Atrial synchronized pacemaker arrhythmias: Revisited

Castellanos, Agustín; Lemberg, L; Rodriguez-Tocker, Lillia; Berkovits, Barouh V.

doi:10.1016/0002-8703(68)90195-6

Cited by 27 publications

(5 citation statements)

References 17 publications

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“…Pacemaker-related tachycardia has already been reported in the early days of cardiac pacing. 4,5 PMT awareness started shortly after the introduction of devices with the capability of sensing and pacing in the atrium and pacing the ventricle synchronous with these atrial events. Due to the properties of the device, retrograde V-A conduction could be sensed by the atrial amplifier, giving rise to ventricular pacing again with V-A conduction, thus initiating pacemaker-mediated or "endless-loop" tachycardia.…”

Section: Discussionmentioning

confidence: 99%

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Initiation of Ventricular Tachycardia by Interruption of Pacemaker‐Mediated Tachycardia in a Patient with a Dual‐Chamber Implantable Cardioverter Defibrillator

Gelder

Meijer

Dekker

et al. 2009

Pacing Clinical Electrophis

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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 . All episodes revealed this pattern of initiation with a short‐long‐short ventricular sequence inducing VT.

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Section: Discussionmentioning

confidence: 99%

“…The PMT is terminated by the tachycardia termination algorithm in episodes 1 and 4, and by atrial undersensing in episodes 2 and 3. After the termination of PMT, the first ventricular paced beat gives retrograde conduction due to atrial noncapture (episode 1) or artificial atrial triggering (episodes[2][3][4].…”

mentioning

confidence: 99%

Initiation of Ventricular Tachycardia by Interruption of Pacemaker‐Mediated Tachycardia in a Patient with a Dual‐Chamber Implantable Cardioverter Defibrillator

Gelder

Meijer

Dekker

et al. 2009

Pacing Clinical Electrophis

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“…After a normal P-ivave triggered systole (1) un eclopic atrial impulse triggers the palse generator [2). The artifact falls in the vulnerable zone ofthe preceding systole and a VES [3 ] follows.…”

Section: Basic Rate Pacing Eliciting Ventricuiar Extrasystojesmentioning

confidence: 99%

Occurrence and Significance of Arrhythmias Associated with Atrial‐Triggered Ventricular Pacing

Levander‐Lindgren

Pehrsson

1984

Pacing Clinical Electrophis

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A review of electrocardiograms from 85 patients with atrial-triggered ventricular pacing (VAT, VDD, DDD) showed that various disturbances of rhythm were relatively common, and that the effects of an arrhythmia could be aggravated by this type of pacing. In certain circumstances even potentially dangerous ventricular extrasystoles were induced by the pacemaker. Abnormal triggering, sometimes with regular sinus rhythm, could also induce tachycardia. Our observations provided indications for a pacemaker design that would avoid such disturbing effects. The best available pacer for atrial-triggered ventricular pacing is the programmable DDD type.

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“…A significant shortcoming of atrial synchronous devices (VAT) is their inability to sense and respond to spontaneous ventricular activity. Several atrial synchronous pacemaker-induced arrhythmias have been shown and suggested (Castellanos et al, 1968). …”

Section: Clinical Applicationmentioning

confidence: 99%

“…One patient showed complete anterograde atrioventricular block but retrograde atrioventricular conduction was preserved. This may lead to atrial synchronous pacemaker-induced tachycardias (Castellanos et al, 1968). In total, 28 (74%) patients were unsuitable for atrial synchronous pacemakers; however, the 15 with abnormal sinus node function and the patient with retrograde atrioventricular conduction should now be considered for DVI atrioventricular sequential pacemakers.…”

Section: Richard Sutton and Paul Citronmentioning

confidence: 99%

Electrophysiological and haemodynamic basis for application of new pacemaker technology in sick sinus syndrome and atrioventricular block.

Sutton¹,

Citron²

1979

Heart

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SUMMARY A fundamental description of pacemaker systems which are commercially available or in clinical validation is given as a background for their application in a series of 62 consecutive patients presenting over a period of 1 year for permanent cardiac pacing. The patients (23 (37%) sick sinus syndrome, 38 (61%) atrioventricular block, and 1 ventricular tachycardia) were studied electrophysiologically and haemodynamically to allow the appropriate application of a pacemaker system. In sick sinus syndrome, 8 patients had permanent atrial pacing, 14 ventricular pacing, and 1 atrioventricular sequential pacing; in atrioventricular block, 8 patients had atrial synchronous ventricular inhibited pacing and the remaining 30 had ventricular pacing. A high incidence of atrial fibrillation, 9 patients, and abnormal sinus node function, 15 patients, precluded wider use of atrial synchrony. The results show benefit in acute haemodynamic studies of using systems including atrial sensing and/or pacing, and with greater availability of atrioventricular sequential and still more advanced pacemakers with dual sensing as well as dual pacing the majority of patients may be offered this benefit. Permanent, implanted cardiac pacemakers have been used clinically since 1959 (Elmqvist and Senning, 1960). As is common with new treatments, the initial indications for use were very narrow, in this instance intended primarily for ventricular stimulation in cases of complete atrioventricular block with Adams-Stokes seizures. These early pacing systems maintained a constant regular cardiac rhythm by stimulating the ventricles asynchronously at a fixed rate, usually 70 pulses per minute. As a fuller understanding of cardiac pacing was realised, indications for use expanded to include management of symptomatic bradyarrhythmias, tachyarrhythmias, and restoration of optimal haemodynamics. As a result, the operational types of artificial pacemakers evolved so that there now exists an armamentarium of atrial and ventricular pacemaker systems, each appropriate to certain pathological situations within a broad range of cardiac diseases.

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Atrial synchronized pacemaker arrhythmias: Revisited

Cited by 27 publications

References 17 publications

Initiation of Ventricular Tachycardia by Interruption of Pacemaker‐Mediated Tachycardia in a Patient with a Dual‐Chamber Implantable Cardioverter Defibrillator

Initiation of Ventricular Tachycardia by Interruption of Pacemaker‐Mediated Tachycardia in a Patient with a Dual‐Chamber Implantable Cardioverter Defibrillator

Occurrence and Significance of Arrhythmias Associated with Atrial‐Triggered Ventricular Pacing

Electrophysiological and haemodynamic basis for application of new pacemaker technology in sick sinus syndrome and atrioventricular block.

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