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Review
. 2021 Jan;7(1):1-5.
doi: 10.1016/j.jacep.2020.10.006.

Novel Pacemaker-Mediated Arrhythmia Without Ventriculoatrial Conduction Can Induce Atrial Fibrillation

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Free article
Review

Novel Pacemaker-Mediated Arrhythmia Without Ventriculoatrial Conduction Can Induce Atrial Fibrillation

Erind Gjermeni et al. JACC Clin Electrophysiol. 2021 Jan.
Free article

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.

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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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