Reliability and Characteristics of Atrial Tachyarrhythmias Detection in Dual Chamber Pacemakers

Abstract

Background: Although atrial high rate episodes (AHRE) have been commonly used to detect atrial tachyarrhythmias (AT/AF) in pacemaker patients, its reliability and characteristics are unclear. Methods and Results:39 patients with implanted dual chamber pacemakers (mean age 79.7±6.6 years), who had no history of AT/AF and were programmed in the setting of AHRE at >190 beats/min in DDD mode, were studied. An atrial overdrive pacing (AOP) algorithm was randomly programmed "ON" in 19 and "OFF" in 20 patients. AHRE were detected in 20 patients (51%), consisting of AT/AF in 15 and repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) in 8 patients, all included in the AOP "ON" group. A total of 257 of 1,528 episodes of AHRE were available for analysis, including 181 and 76 episodes in the AOP "ON" and "OFF" groups, respectively. Among 181 episodes in the AOP "ON" group, 72 (40%) were RNRVAS, whereas all episodes in the AOP "OFF" group (100%) were AT/AF. Detection of RNRVAS was closely associated with a high cumulative % atrial pacing. The specificity of AT/AF detection by AHRE was 40% when the AOP algorithm was activated, vs. 100% when not in use.Conclusions: AT/AF was common in pacemaker patients without a history of AT/AF. The increase in cumulative % atrial pacing and the use of an AOP algorithm might be closely associated with RNRVAS, non-AT/AF, detected by AHRE. (Circ J 2011; 75: 1090 - 1097

Atrial Pacing Site and Atrioventricular Conduction in Patients Paced for Sinus Node Disease

“…However, an increase in atrial pacing rate with a fixed programmed AV interval lengthens the intrinsic AV conduction time and increases the rate of ventricular paced events. Longer programmed AV intervals caused by a higher atrial pacing rate may occasionally cause pacemaker syndrome or pacemaker‐induced tachyarrhythmias . While in this study, the Ap‐Vs interval increased gradually as the atrial pacing rate increased in both study groups, the As‐Vs interval associated with RAA pacing was significantly and consistently longer than that associated with LRAS pacing.…”

“…However, a prolonged PR interval may cause manifestations similar to those observed in the pacemaker syndrome, such as fatigue, palpitation, shortness of breath, orthopnea, and near syncope, even in absence of high degree AV block . Furthermore, very long PR intervals associated with pacing algorithms to limit ventricular pacing may worsen the clinical outcomes, despite successful limitation of ventricular pacing . Sweeney et al .…”

“…They hypothesized that an excessive prolongation of the PR interval by atrial pacing adversely influences the cardiac mechanics (AV dyssynchronization) compared with sinus rhythm at any heart rates, particularly in patients presenting with a low LV ejection fraction. In addition, an excessively prolonged AV delay may cause the pacemaker syndrome or pacemaker‐induced tachyarrhythmias …”

Detection of atrial tachyarrhythmias in an implantable monitoring device

“…Furthermore, the presence of VA conduction may cause RNRVAS or PMT. Although FFRW sensing, RNRVAS, and PMT are not atrial tachyarrhythmias, they (a) are considered AT/AF episodes by implantable monitoring devices, (b) may be the source of inaccurate diagnostic information and inappropriate AMS from DDD to DDI or VVI mode, and (c) may trigger AT/AF or cause pacemaker syndrome [10–20].…”

Remote Monitoring Leads to Early Recognition and Treatment of Critical Arrhythmias in Adults After Atrial Switch Operation for Transposition of the Great Arteries

“…17 Kohno et al reported on 20 adult patients with a DDD pacemaker system, of whom 75% developed asymptomatic atrial tachycardia or atrial flutter/fibrillation during a mean follow-up period of 17 months. 18 Two of the present 3 RM patients with atrial flutter presented with a thrombus formation on an atrial lead and in cardiac failure, respectively, due to unrecognized atrial flutter before inclusion into the study.…”