Syncope after successful implantation of atrioventricular synchronous leadless pacemaker caused by polymorphic ventricular tachycardia

Leadless atrioventricular synchronous pacing in an outpatient setting: Early lessons learned on factors affecting atrioventricular synchrony

“…Due to the dependency of the timing of A3 and A4 on heart rate, the device's delineation of A4 signals depends on an adequate parameter setting. Otherwise, AV synchrony may be perturbed and the risk of malignant arrhythmias might increase 13 . We consistently programmed the A3 window earlier (shortening of min.…”

Sustained ventricular arrhythmia after implantation of helix-fixation leadless pacemaker

“…The potential proarrhythmic effect of cardiac pacing is a rare but well-described phenomenon with LPs. 2 , 3 , 4 , 5 , 6 , 7 , 8 During the initial 140 implantations of the Micra transcatheter pacing system, Ritter and colleagues 2 reported 2 cases of ventricular tachycardia and 1 case of ventricular fibrillation. From a cohort of 92 Micra implants in Switzerland, Valiton and colleagues 4 reported a case of intractable VT after Micra implant.…”

“…In previously reported cases, “short-long-short” sequences that set the stage for “R-on-T”-induced ventricular arrhythmia and myocardial ischemia or scar have been proposed as potential causes of ventricular arrhythmia post LP implant. 3 , 6 , 8 …”

“…Pacing-mediated ventricular arrhythmias including both polymorphic ventricular tachycardia (PMVT) and monomorphic ventricular tachycardia have previously been reported after tine-based Micra TM (Medtronic plc, Minneapolis, MN) LP implantation. 2 , 3 , 4 , 5 , 6 , 7 , 8 Here, we report the first case of symptomatic ventricular arrhythmia following a helix-fixation Aveir VR LP implant, which led to diagnosis of previously unrecognized obstructive coronary artery disease (CAD). The ventricular arrhythmia was resolved with retrieval of the LP.…”

Atrioventricular synchronous leadless pacemaker: state of art and broadened indications

“…In this case, the Micra-AV was initially implanted as a bridge therapy after biventricular pacemaker lead extraction, until a new transvenous biventricular system could be reimplanted after a complete resolution of the infectious process. Similarly, Halawa et al [20] reported a case of a polymorphic ventricular tachycardia caused by atrial undersensing during VDD pacing, that led to "short-long-short" sequences or "R-on-T" phenomenon. As the authors suggested, this event may show a relationship with specific Micra-AV algorithms sought to minimize ventricular pacing.…”