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. 2023 Jun;46(6):467-474.
doi: 10.1111/pace.14662. Epub 2023 Jan 30.

Pseudo repetitive non-reentrant ventriculoatrial synchrony: Current challenges

Erind Gjermeni  1   2 , Michael Doering  1 , Gerhard Hindricks  1 , Kerstin Bode  1
Affiliations

Pseudo repetitive non-reentrant ventriculoatrial synchrony: Current challenges

Erind Gjermeni et al. Pacing Clin Electrophysiol. 2023 Jun.

Abstract

Background: We recently described a novel pacemaker-mediated arrhythmia in Abbott cardiac implantable electronic devices (CIED), called pseudo-RNRVAS, that mimics repetitive non-reentrant ventriculoatrial synchrony (RNRVAS), but can appear in patients with ventriculoatrial (VA) block. It is caused by sinus-p-waves, trapped in the post-ventricular atrial refractory period (PVARP), which mimic VA conduction. The p-waves are followed by atrial pacing during the myocardial refractory time, which can trigger atrial fibrillation (AF). Pseudo-RNRVAS and RNRVAS are probably more common than appreciated, but the recognition and differentiation of the two can be challenging because most CIEDs do not recognize and store them.

Objective: We illustrate practical challenges in the assessment of Pseudo-RNRVAS and provide programming options that proved safe and effective for preventing Pseudo-RNRVAS and reducing the risk for typical RNRVAS.

Methods and results: We illustrate in 10 patients the characteristics of Pseudo-RNRVAS and their treatment. The outcome regarding the recurrence of pseudo-RNRVAS after 6 months of follow-up was collected. Inappropriate atrial pacing during pseudo-RNRVAS resulted in AF in six patients. After shortening the PVARP in nine, inactivation/reduction of rate response in four, and reduction of the basic pacing rate in one patient, pseudo-RNRVAS was avoided in eight patients and reduced in one. In one patient AF became permanent.

Conclusions: Pseudo-RNRVAS is a pacemaker-mediated arrhythmia that can appear in patients without VA conduction and may lead to AF. The suggested adjustments of pacing parameters were safe and effective in preventing the arrhythmia.

Keywords: atrial fibrillation; dual-chamber pacemaker; inappropriate modeswitch; pacemaker-mediated arrhythmia; repetitive non-reentrant ventriculoatrial synchrony.

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References

REFERENCES

    1. Brignole M, Auricchio A, Baron-Esquivias G, et al. 213 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2013;34:2281-2329.
    1. Barold SS, Stroobandt R, Sinnaeve AF, Barold SS. Cardiac Pacemakers and Resynchronization Therapy Step-by-step: An Illustrated Guide. 2nd edition. Wiley-Blackwell; 2010.
    1. Monteil B, Ploux S, Eschalier R, et al. Pacemaker-mediated tachycardia: manufacturer specifics and spectrum of cases. PACE - Pacing Clin Electrophysiol. 2015;38:1489-1498.
    1. Barold S. Repetitive reentrant and non-reentrant ventriculoatrial synchrony in dual chamber pacing. Clin Cardiol. 1991;14:754-763.
    1. Sharma PS, Kaszala K, Tan AY, et al. Repetitive nonreentrant ventriculoatrial synchrony: an underrecognized cause of pacemaker-related arrhythmia. Heart Rhythm. 2016;13:1739-1747.

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