Pacemaker mediated tachycardia as a complication of the autointrinsic conduction search function.
The autointrinsic conduction search (AICS) option, featured on some DDD pacemakers, performs periodic assessments of atrioventricular (AV) conduction capability during a single beat AV delay extension. Demonstration of ventricular conduction during the prolonged AV delay, permits ongoing AV delay extension if the patient's intrinsic conduction is preferred to ventricular pacing. A case is presented where the wide separation of atrial and ventricular pacing during the conduction search permitted retrograde ventriculoatrial conduction, precipitating pacemaker mediated tachycardia (PMT) on seven occasions in one patient. Two onset patterns are reported, both attributable to the AICS option. Recommendations for prevention strategies are made.
Dennis
Malcolm J
MJ
Intensive Care Unit, Epworth Hospital, Melbourne, Australia. malcolmd@epworth.org.au
Sparks
Paul B
PB
D000368:Aged; D000369:Aged, 80 and over; D001283:Atrioventricular Node / Q000503:physiopathology*; D004562:Electrocardiography; D019544:Equipment Failure Analysis; D006325:Heart Atria / Q000503:physiopathology; D006327:Heart Block / Q000503:physiopathology / Q000628:therapy*; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008838:Microcomputers; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012984:Software; D013610:Tachycardia / Q000503:physiopathology*