title: Pacemaker-Mediated Tachycardia: Manufacturer Specifics and Spectrum of Cases.
abstract: Pacemaker-mediated tachycardia (PMT) is the term used to describe a repetitive sequence of sensed retrograde P waves followed by ventricular pacing at or below the maximum tracking rate. The following events can promote atrioventricular (AV) dissociation, retrograde conduction, and the onset of PMT: ventricular or atrial extrasystole, an excessively long programmed AV delay, external interference or myopotentials sensed by the atrial channel, atrial sensing or pacing failure, the absence of postventricular atrial refractory period extension after removal of a magnet, and VDD pacing at a higher rate than sinus rate. In contemporary devices, each manufacturer has a proprietary algorithm to detect and terminate PMT. Because of the increase in the number and complexity of the pacing algorithms and because of manufacturer-driven differences, a basic understanding of these new algorithms is important for patient care. We review here the main elements of the physiopathology of this type of tachycardia, describe the specific characteristics of the different manufacturers, and present representative clinical cases.
authors.affiliation: Department of Cardiology, Hôpital Rangueil, Toulouse, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Monteil
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Jayanthi N
authors.initials: JN
authors.lastname: Koneru
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013610:Tachycardia / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: endless loop tachycardia; pacemaker-mediated tachycardia; pacing