title: Accuracy of the pacemaker-mediated tachycardia algorithm in Boston Scientific devices.
abstract: The incidence of pacemaker-mediated tachycardia (PMT) varies as a function of patient characteristics, device programming and algorithm specificities. We investigated the efficacy of the Boston Scientific algorithm by reviewing PMT episodes in a large device population.
  
  
  
  In this multicenter study, we included 328 patients implanted with a Boston Scientific device: 157 non-dependent patients with RYTHMIQ™ activated (RYTHMIQ group), 76 patients with permanent AV-conduction disorder (AV-block group) and 95 Cardiac Resynchronization Therapy patients (CRT group). For each patient, we reviewed the last 10 remote monitoring-transmitted EGMs diagnosed as PMT.
  
  
  
  We analyzed 784 PMT episodes across 118 patients. In the RYTHMIQ group, the diagnosis of PMT was correct in most episodes (80%) of which 69% was directly related to the prolongation of the AV-delay associated with the RYTHMIQ algorithm. The usual triggers for PMT were also observed (PVC 16%, PAC 9%). The remainder of the episodes (20%) in RYTHMIQ patients and most episodes of AV-block (66%) and CRT patients (74%) were incorrectly diagnosed as PMT during sinus tachycardia at the maximal tracking rate. The inappropriate intervention of the algorithm during exercise causes non-conducted P-waves, loss of CRT (sustained in six patients) and may have been pro-arrhythmogenic in one patient (induction of ventricular tachycardia).
  
  
  
  Algorithms to minimize ventricular pacing can occasionally have unintended consequences such as PMT. The PMT algorithm in Boston Scientific devices is associated with a high rate of incorrect PMT diagnosis during exercise resulting in inappropriate therapy with non-conducted P-waves, loss of CRT and limited risk of pro-arrhythmic events.
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. Electronic address: m.strik@maastrichtuniversity.nl.
authors.forename: M
authors.initials: M
authors.lastname: Strik
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
authors.forename: A
authors.initials: A
authors.lastname: Frontera
authors.affiliation: Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, CHU Clermont-Ferrand, Cardiology Department, F-63003, Clermont-Ferrand, France.
authors.forename: R
authors.initials: R
authors.lastname: Eschalier
authors.affiliation: Centre Hospitalier Universitaire de Grenoble, La Tronche, France.
authors.forename: P
authors.initials: P
authors.lastname: Defaye
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Mondoly
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
authors.forename: P
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
authors.forename: M
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
authors.forename: S
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Haut-Lévêque Hospital, Centre, Hospitalier Universitaire de Bordeaux; LIRYC institute, Pessac, France.
authors.forename: P
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation* / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000295:instrumentation* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000517:prevention & control*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Clinical: cardiac mapping – electrogram analysis; Clinical: implantable devices – biventricular pacing/defibrillation; Clinical: implantable devices – pacemaker-bradyarrhythmias; Clinical: implantable devices – physiologic pacing; Clinical: implantable devices – ventricular tachycardia/fibrillation