Arrhythmias Caused by Dual-Chambered Pacing
The recent release ofDDD (and VDD) pulse generators with relatively short atrial refractory periods has set the stage for the development of endless loop or electronic reentry tachycardias because of the frequent occurrence of retrograde V A conduction in patients requiring permanent pacing. The absence of VA conduction during electrophysiologic testing at the time of implantation does not necessarily predict protection against endless loop tachycardia because VA conduction may occasionally become manifest only after implantation. Programmability of the atrial refractory period constitutes the most important pacemaker characteristic for the prevention of endless loop tachycardia. We have found chest wall stimulation a useful technique for the verification of the programmed upper atrial tracking rate, duration of the pacemaker atrial refractory period, and characterization of the predicted response to the upper programmed rate. Chest wall stimulation can initiate and terminate endless loop tachycardia in patients predisposed to this arrhythmia.
Potentially serious repetitive ventricular firing or tachycardia may occasionally be caused by a normally functioning DVI or DDD pulse generator. The problem of cross-talk or self-inhibition is unique to dual-chambered pacemakers and remains a potential problem despite the incorporation of a ventricular blanking period.
KeywordsPulse Generator Sick Sinus Syndrome Ventricular Extrasystole Versus Interval Permanent Pace
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Hayes DL, Furman S: Atrio-ventricular and Ventriculo-atrial conduction times in patients undergoing pacemaker implant. Pace 1983; 6: 38–46.CrossRefPubMedGoogle Scholar
Tolentino AO, Javier RP, Byrd C, Samet P. Pacer-induced tachycardia associated with an atrialsynchronous ventricular-inhibited (ASVIP) pulse generator. Pace: 1982; 5: 251–259.CrossRefPubMedGoogle Scholar
Bathen J, Gundersen T, Forfang K: Tachycardias related to atrial synchronous ventricular pacing. Pace 1982; 5: 471–475.CrossRefPubMedGoogle Scholar
Furman S, Fisher JD: Endless loop tachycardia in an A V universal (DDD) pacemaker. Pace 1982; 5: 486–489.CrossRefPubMedGoogle Scholar
Furman S, Cooper JA: Atrial fibrillation during A V sequential pacing. Pace: 1982; 5: 133–135.CrossRefPubMedGoogle Scholar
Luceri RM, Ramirez AV, Castellanos A, Zaman L, Thurer RJ, Myerburg RJ: Ventricular tachycardia produced by a normally functioning A V sequential demand (DVn pacemaker with “committed” ventricular stimulation. J Am Coll Cardiol 1983; 1: 1177–1179.CrossRefPubMedGoogle Scholar
Freedman RA, Rothman MT, Mason JW: Recurrent ventricular tachycardia induced by an atrial synchronous ventricular-inhibited pacemaker. Pace 1982; 5: 490–494.CrossRefPubMedGoogle Scholar
Furman S, Reicher-Reiss H, Escher DJW: Atrioventricular sequential pacing and pacemakers. Chest: 1973; 63: 783–789.CrossRefPubMedGoogle Scholar
DenDulk K, Lindemans FW, Bar FW, Wellens HJJ: Pacemaker related tachycardias. Pace 1982; 5: 476–485.CrossRefGoogle Scholar
Barold SS, Falkoff MD, Ong LS, Heinle RA: Interpretation of electrocardiograms produced by a new unipolar muitiprogrammable “committed” AV sequential demand (DVI) pulse generator. Pace 1981; 4: 692–708.CrossRefPubMedGoogle Scholar
© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1983