Pacemaker repetitive nonreentrant ventriculoatrial synchrony. Why did automatic mode switching occur?

Barold, S. Serge; Stroobandt, Roland X.; Heuverswyn, Frédéric Van

doi:10.1016/j.jelectrocard.2012.04.003

Cited by 27 publications

(34 citation statements)

References 6 publications

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“…Repetitive, nonreentrant VA synchrony (RNRVAS) is not a rare phenomenon with dual‐chamber pacemakers 1,2 . Most previously described cases of RNRVAS, which accelerate the pacing rate, have been associated with sensor‐driven DDDR pacing 1,2 . This form of VA synchrony is associated with programmed long AV intervals and relatively high atrial rates during DDD or DDDR pacing.…”

Section: Discussionmentioning

confidence: 99%

Failure of Atrial Capture during DDIR Pacing in a Patient with Sinus Node Disease and Preserved Atrioventricular Conduction: What Is the Mechanism?

Kohno¹,

Abe

Oginosawa³

et al. 2011

Pacing Clinical Electrophis

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cardiac pacing, sick sinus syndrome, repetitive nonreentrant VA synchrony, rate-responsive pacing Case PresentationA 66-year-old man underwent implantation of a model 5826, Zephyr TM XL DR pacemaker (St. Jude Medical, Sylmar, CA, USA) for management of sinus node dysfunction associated with paroxysmal atrial fibrillation (AF). Models 1999 and 2088TC active-fixation leads (St. Jude) were implanted in the right atrial appendage and right ventricular mid septum, respectively. Since the sinus rate was 36 beats per minute (bpm) with frequent sinus arrests and episodes of AF, the pacemaker was programmed in DDIR mode with a backup rate of 60 pulses per minute (ppm), maximum sensor-driven rate limit at 120 ppm, and a 300-ms paced atrioventricular (AV) interval. The postventricular atrial refractory periods (PVARP) and postventricular atrial blanking period were set at 275 and 140 ms, respectively. The rate response was programmed "ON," with an auto (+2) response slope, and reaction and recovery times set to fast and medium, respectively. The rate-responsive AV delay was programmed "OFF," the rate-responsive PVARP "LOW," and shortest PVARP at 170 ms. Far-field R-wave oversensing was prevented by the postventricular atrial blanking period setting. The atrial high-rate episodes (AHRE) function was activated to detect atrial rates >170 bpm. Since the P-wave sensing and atrial capture threshold were 2.4-2.7 mV and 0.75 V/0.4 ms, respectively, the atrial sensitivity and pulse amplitude were set at 0.2 mV and 2.5 V/0.4 ms, respectively. Oral bepridil, 150 mg t.i.d., was administered for the prevention of paroxysmal AF.The intracardiac electrograms (iEGM) of recorded AHRE were reviewed 1 week after pacemaker implantation. The recording in Figure 1 shows that while the patient was climbing up and downstairs the sensor-driven atrial pacing (AP) rate increased to 80 ppm. The ventriculoatrial (VA) interval after ventricular pacing (VP) was 220 ms, and the atrial electrogram induced by VA conduction was sensed within the PVARP. Sensor-driven, rate-adaptive DDIR pacing occurred 200 ms after the retrograde P wave was sensed. However, the atrium was not captured, because of persistent refractoriness. Following this ineffective atrial paced event, VP occurred at the programmed AV interval of 300 ms. This lasted for 1 minute 36 seconds, while the patient continued to climb up and downstairs. Pacemaker interrogation revealed normal pacing and sensing thresholds and lead impedances. What is the mechanism of the noncaptured AP and continuous VP in this patient with sinus node dysfunction? DiscussionRepetitive, nonreentrant VA synchrony (RNR-VAS) is not a rare phenomenon with dual-chamber pacemakers. 1,2 Most previously described cases of RNRVAS, which accelerate the pacing rate, have been associated with sensor-driven DDDR pacing. 1,2 This form of VA synchrony is associated with programmed long AV intervals and relatively high atrial rates during DDD or DDDR pacing. We have recently reported a case of RNRVAS, recorded as AHRE in the pacemak...

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Section: Discussionmentioning

confidence: 99%

Failure of Atrial Capture during DDIR Pacing in a Patient with Sinus Node Disease and Preserved Atrioventricular Conduction: What Is the Mechanism?

Kohno¹,

Abe

Oginosawa³

et al. 2011

Pacing Clinical Electrophis

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“…Similar to the classic PMT, this occurs in patients with a dual‐chamber device with AV sequential pacing and retrograde VA conduction. Its initiation and termination is very similar to classic PMT …”

Section: Introductionmentioning

confidence: 55%

Pacemaker‐mediated arrhythmias

Alasti

Machado

Rangasamy

et al. 2018

Journal of Arrhythmia

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Pacemakers can be directly involved in initiating or sustaining different forms of arrhythmia. These can cause symptoms such as dyspnea, palpitations, and decompensated heart failure. Early detection of these arrhythmias and optimal pacemaker programming is pivotal. The aim of this review article is to summarize the different types of pacemaker‐mediated arrhythmias, their predisposing factors, and mechanisms of prevention or termination.

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“…The main triggering factor is the functional undersensing of a retrogradely conducted atrial event when the next scheduling of AP coincides within the tissue refractoriness resulting in a noncaptured beat. The tracked ventricular event subsequently results in a repetitive manner of sequential pacing in the form of RNRVAS . However, this does not pose a risk with a long ARP during AAI operation of the MVP mode as once the requisite for DDD mode switch is met (see above), NCAP is simultaneously activated.…”

Section: Discussionmentioning

confidence: 99%

Mode Switching during Managed Ventricular Pacing Algorithm: What Is the Mechanism?

Almehairi

Simpson

Caldwell

et al. 2013

Pacing Clinical Electrophis

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Pacemaker repetitive nonreentrant ventriculoatrial synchrony. Why did automatic mode switching occur?

Cited by 27 publications

References 6 publications

Failure of Atrial Capture during DDIR Pacing in a Patient with Sinus Node Disease and Preserved Atrioventricular Conduction: What Is the Mechanism?

Failure of Atrial Capture during DDIR Pacing in a Patient with Sinus Node Disease and Preserved Atrioventricular Conduction: What Is the Mechanism?

Pacemaker‐mediated arrhythmias

Mode Switching during Managed Ventricular Pacing Algorithm: What Is the Mechanism?

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