How to Induce Pacemaker-Mediated Tachycardia?
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Pacemakers are devices that are used worldwide for bradyarrhythmias. They are robust devices that function properly from implantation to depletion of battery. Rarely malfunctions appear, one of them being pacemaker-mediated tachycardia in patients implanted with double-chamber devices when retrograde ventriculoatrial conduction is present. Retrograde ventriculoatrial conduction can be present in up to 50–70% of normal patients. In patients with a normal heart, usually it does not manifest clinically. Even in the case of an advanced AV block, retrograde VA conduction can still be present. Patients implanted with a cardiac device like pacemakers or defibrillators can exhibit ventriculoatrial conduction: 14% of patients with complete AV block and up to 80% of patients with sinus node disease. In patients with double-chamber pacemakers or double-chamber defibrillators, using an atrial sensing mode can serve as a second AV pathway and support reentry: antegrade pathway through the pacemaker and retrograde pathway through the AV node.
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