Novel Pacemaker-Mediated Arrhythmia Without Ventriculoatrial Conduction Can Induce Atrial Fibrillation
- PMID: 33478700
- DOI: 10.1016/j.jacep.2020.10.006
Novel Pacemaker-Mediated Arrhythmia Without Ventriculoatrial Conduction Can Induce Atrial Fibrillation
Abstract
Cardiovascular implantable electronic devices can initiate and sustain pacemaker-mediated arrhythmias. Endless loop tachycardia and repetitive non-re-entrant ventriculoatrial synchrony (RNRVAS) are well-described examples of pacemaker-mediated arrhythmias. However, such arrhythmias only occur in the presence of ventriculoatrial conduction. We identified a novel pacemaker-mediated arrhythmia that closely mimics RNRVAS but in the absence of ventriculoatrial conduction. We identified these arrhythmias in 9 patients, all with a St. Jude Medical/Abbott device, recorded as inappropriate mode-switch episodes by a device algorithm that includes paced events in the atrial counter. This report describes the mechanism, discusses clinical implications, and outlines programming options to eliminate this pseudo-RNRVAS.
Keywords: atrial fibrillation; dual-chamber pacemaker; inappropriate mode-switch; novel arrhythmia; pacemaker-mediated arrhythmia; repetitive non-re-entrant ventriculoatrial synchrony.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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