title: Repetitive nonreentrant ventriculoatrial synchrony: An underrecognized cause of pacemaker-related arrhythmia.
abstract: Similar to endless loop tachycardia (ELT), repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) is a ventriculoatrial (VA) synchrony pacemaker-mediated arrhythmia. RNRVAS was first described in 1990 and can only occur in the presence of retrograde VA conduction and dual-chamber or cardiac resynchronization devices with tracking (P-synchronous ventricular pacing such as DDD, DDDR) or nontracking pacing modes that allow AV-sequential pacing (DDI, DDIR). RNRVAS is promoted by (1) high lower rate limit or any feature that allows rapid pacing, (2) long AV intervals, or (3) long postventricular atrial refractory period (PVARP). In contrast to ELT, RNRVAS is a less well-recognized form of pacemaker-mediated arrhythmia; thus, unlike ELT, there are no specific device algorithms to prevent, recognize, and terminate RNRVAS. However, RNRVAS has been recently shown to occur frequently. We present a series of cases, some of which were found fortuitously. Owing to its clinical implications, we propose that algorithms should be developed to prevent, identify, and terminate RNRVAS.
authors.affiliation: Virginia Commonwealth University / Pauley Heart Center, Richmond, Virginia.
authors.forename: Parikshit S
authors.initials: PS
authors.lastname: Sharma
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.
authors.forename: Karoly
authors.initials: K
authors.lastname: Kaszala
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.
authors.forename: Alex Y
authors.initials: AY
authors.lastname: Tan
authors.affiliation: Virginia Commonwealth University / Pauley Heart Center, Richmond, Virginia.
authors.forename: Jayanthi N
authors.initials: JN
authors.lastname: Koneru
authors.affiliation: Virginia Commonwealth University / Pauley Heart Center, Richmond, Virginia.
authors.forename: Richard
authors.initials: R
authors.lastname: Shepard
authors.affiliation: Virginia Commonwealth University / Pauley Heart Center, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia. Electronic address: jfhuizar@gmail.com.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Huizar
mesh_terms: D004562:Electrocardiography; D004868:Equipment Failure; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013610:Tachycardia / Q000209:etiology*
keywords: Dual-chamber pacemaker; Mode switching; Pacemaker syndrome; Pacemaker-mediated arrhythmia; Repetitive nonreentrant VA synchrony; Retrograde VA conduction