Orthodromic pacemaker-mediated tachycardia in a biventricular system without an atrial electrode

Journal of Cardiovascular Electrophysiology
Antonio BerruezoJosep Brugada

Abstract

Pacemaker-mediated tachycardia is a well-known complication of dual-chamber devices. In this report, we describe for the first time a case of orthodromic pacemaker-mediated tachycardia in a patient in whom a biventricular system without an atrial electrode had been implanted. Retrograde atrial activation was directly produced by the dislodged coronary vein electrode in the AV groove, resulting in simultaneous capture of the left atrium and left ventricle. During tachycardia, AV nodal conduction was via the anterograde pathway of the circuit and limited the ventricular response. Subsequently, right ventricular activation was sensed by the right ventricular electrode that triggered biventricular pacing and left atrial capture, perpetuating the tachycardia. Because the left atrial threshold was higher than the left ventricular threshold, the problem could be resolved easily by lowering the output of the coronary vein electrode.

References

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Citations

Jan 5, 2011·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Óscar AlcaldeDamià Pereferrer
May 30, 2008·Pacing and Clinical Electrophysiology : PACE·Marek Jastrzebski
Jun 16, 2010·Pacing and Clinical Electrophysiology : PACE·Csaba HerczkuZoltan Csanadi
May 7, 2014·Pacing and Clinical Electrophysiology : PACE·S Serge BaroldAndreas Kucher
Jun 9, 2018·Clinical Case Reports·Hyun Sok YooRafael Acunzo
Oct 18, 2018·Journal of Arrhythmia·Mohammad AlastiJeff Alison
Oct 16, 2020·Pacing and Clinical Electrophysiology : PACE·Christopher MonkhouseJonathan Behar

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