Method of atrioventricular programming in atrial flutter in patients with biventricular pacemaker.
BACKGROUND
Atrial flutter is a common cause of exacerbation of congestive heart failure (CHF). Typically, during atrial tachycardia, pacemakers, both dual and biventricular, are programmed to ignore atrial tracking. Virtually all current pacemakers and defibrillators use a programmable mode switch algorithm to switch between atrial tracking modes (DDD, DDDR) to nontracking modes (DDIR, DDI, VVI) during episodes of atrial tachycardia.


METHODS
In this report, we describe a novel method of atrioventricular (AV) pacemaker programming in four patients with atrial flutter and CHF who remained symptomatic postbiventricular pacemaker implantation. All patients had chronic atrial flutter upon interrogation; adjustment of AV delay and postventricular atrial refractory period (PVARP) was performed to enable sensing of every second to fourth atrial flutter beat by the atrial lead. Mode switch was turned "OFF" in all points, and lower and upper rate limits were set to 50 and 100 bpm. Once sequential early and late diastolic filling was seen on mitral inflow pulsed-wave (PW) Doppler, further adjustment of AV delay and PVARP was performed until the highest and broadest atrial velocity occurred on mitral inflow PW Doppler.


RESULTS
All patients developed improvement in aortic ejection duration and peak ejection velocity during AV optimization. Repeat ECG in these patients at 8 months, 7 days, 2 days, and 2 months postoptimization showed no change in P and QRS relationship. All patients developed improvement in CHF symptoms postbiv pacemaker optimization.


CONCLUSIONS
In symptomatic patients with CHF and stable atrial flutter who have a biventricular pacemaker, atrial mechanical contribution to cardiac output can be achieved by adjusting PVARP and AV delay during echo-guided pacemaker programming.
Cardiac Non-Invasive Laboratory, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. tasneem.naqvi@cshs.org
Tasneem Z
TZ
Naqvi
William
W
Barnett
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001282:Atrial Flutter / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004867:Equipment Design; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial