Pacemaker Troubleshooting and Follow-up

Love, Charles J.

doi:10.1016/b978-1-4377-1616-0.00029-1

Cited by 5 publications

(5 citation statements)

References 208 publications

(187 reference statements)

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“…This algorithm mandates atrial pacing (AP) at the end of the AA period that ranges from 330–350 ms. This interval is usually sufficient for the atrial myocardium to recover refractoriness, allowing for capture, and precluding retrograde conduction of the next ventricular paced event 2 …”

Section: Commentarymentioning

confidence: 99%

“…A single DVI cycle represents the ultimate PVARP extension, because the atrial channel remains refractory to sensing throughout the entire atrial escape interval. The aforementioned techniques are limited by the occurrence of functional atrial noncapture that can result in the occurrence of ELT after the paced AV cycle that follows the PVC and can be overcome by the addition of an AA interval that delays AP until the atrial myocardium recovers refractoriness as described in the case above 2 . Other reported methods to prevent ELT include differential atrial sensing and atrial rate acceleration detection algorithms.…”

Section: Commentarymentioning

confidence: 99%

See 1 more Smart Citation

Atrial Pace on PVC Algorithm Inducing Ventricular Fibrillation

El-Damaty¹,

Gray²,

Sharma³

et al. 2011

Pacing Clinical Electrophis

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proarrhythmia, PVC response, implantable cardiovertor defibrillator, atrial pace on PVC Case PresentationA 62-year-old man presented to the hospital following an episode of syncope and implantable cardiovertor defibrillator (ICD) shock. He was known to have ischemic cardiomyopathy, prior coronary artery bypass grafting in 2007, and a dual-chamber ICD, a Current Accel DR (St. Jude Medical, Inc., Minneapolis, MN, USA) implanted in 2009 following a ventricular fibrillation (VF) arrest.Device interrogation revealed a VF episode that was successfully terminated with a 36-J shock. Testing of the atrial and ventricular leads demonstrated adequate pace/sense function and normal lead impedances. Device parameters were as follows: DDD mode with a base rate of 40 beats per minute (rate response sensor was passive), postventricular atrial refractory period (PVARP) was 275 ms, ventricular intrinsic preference (VIP) was enabled and programmed to 100-ms extension (a setting to prolong the atrioventricular [AV] delay and permit intrinsic conduction), and premature ventricular contraction (PVC)/pacemakermediated tachycardia responses were enabled. Tachycardia detection was set to three zones, with the ventricular tachycardia 1 (VT1) zone starting at 375 ms, VT2 starting at 320 ms, and VF zone starting at 280 ms. Therapy was programmed with antitachycardia pacing followed by shocks in the first two zones and shocks only in the VF zone. The presenting episode is shown in Figure 1. What is the most likely mechanism of initiation of this VF episode; is it likely related to the underlying Conflict of interest:

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Atrial Pace on PVC Algorithm Inducing Ventricular Fibrillation

El-Damaty¹,

Gray²,

Sharma³

et al. 2011

Pacing Clinical Electrophis

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“…These observations indicate that this second beat was triggered by a sense event in the atrial channel. A differential diagnosis at this stage should include premature atrial contractions, oversensing of either the T‐wave or the final part of the QRS complex, and retrograde atrial depolarization 1–3 . A search for preceding P‐waves revealed obvious deflections immediately after the QRS complex, most clearly visible in the V 1 lead.…”

Section: Commentarymentioning

confidence: 99%

“…In the present patient, the paced atrio‐ventricular (AV) delay was programmed to 300 ms (at an office visit 6 months prior), to promote intrinsic AV conduction. A long AV delay interval permits the AV junction to recover, and is a recognized cause of retrograde conduction leading to pacemaker endless loop tachycardia (ELT) 3 . Indeed, after the second beat in each pair, another apparently retrograde P‐wave was noted.…”

Section: Commentarymentioning

confidence: 99%

Pacemaker‐Mediated Bigeminy: What Is the Mechanism?

Jastrzębski¹

2010

Pacing Clinical Electrophis

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“…We report an episode of device‐related arrhythmia observed with a dual‐chamber implantable cardioverter defibrillator (ICD). A repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) [1,2] occurred in a patient with poor left ventricular function due to a dilated cardiomyopathy and caused the worsening of heart failure. This pacemaker‐mediated arrhythmia can be induced in patients with retrograde conduction, high basic heart rate, and long postventricular atrial refractory period (PVARP), and an algorithm called noncompetitive atrial pacing (NCAP) is effective to prevent pacemaker‐mediated tachycardia.…”

Section: Introductionmentioning

confidence: 99%

A case of repetitive nonreentrant ventriculoatrial synchrony exacerbating heart failure in dilated cardiomyopathy

Toyoshima

Inoue

Kimura

et al. 2012

Journal of Arrhythmia

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a b s t r a c tA 67-year-old man with poor left ventricular function due to a dilated cardiomyopathy was implanted with an implantable cardioverter defibrillator for secondary prevention. Eight years later, he was admitted to our hospital with worsening of heart failure. An electrocardiogram showed a repetitive nonreentrant ventriculoatrial synchrony (RNRVAS). RNRVAS is a device-related arrhythmia that can occur when a dual-chamber pacemaker does not sense a retrograde P wave within the postventricular atrial refractory period, resulting in a repetitive ventricular pacing and noncaptured atrial pacing after the retrograde P wave. We suspected that ventricular pacing caused his heart failure and used the noncompetitive atrial pacing algorithm, which was programmed to prevent RNRVAS. The algorithm was able to prevent the arrhythmia, and the patient successfully recovered from heart failure.

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Pacemaker Troubleshooting and Follow-up

Cited by 5 publications

References 208 publications

Atrial Pace on PVC Algorithm Inducing Ventricular Fibrillation

Atrial Pace on PVC Algorithm Inducing Ventricular Fibrillation

Pacemaker‐Mediated Bigeminy: What Is the Mechanism?

A case of repetitive nonreentrant ventriculoatrial synchrony exacerbating heart failure in dilated cardiomyopathy

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