Abstract
Pacemakers are devices that are used worldwide for bradyarrhythmias. They are robust devices that function properly from implantation to depletion of battery. Rarely malfunctions appear, one of them being pacemaker-mediated tachycardia in patients implanted with double-chamber devices when retrograde ventriculoatrial conduction is present. Retrograde ventriculoatrial conduction can be present in up to 50–70% of normal patients. In patients with a normal heart, usually it does not manifest clinically. Even in the case of an advanced AV block, retrograde VA conduction can still be present. Patients implanted with a cardiac device like pacemakers or defibrillators can exhibit ventriculoatrial conduction: 14% of patients with complete AV block and up to 80% of patients with sinus node disease. In patients with double-chamber pacemakers or double-chamber defibrillators, using an atrial sensing mode can serve as a second AV pathway and support reentry: antegrade pathway through the pacemaker and retrograde pathway through the AV node.
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References
Westveer DC, Stewart JR, Goodfleish R, Gordon S, Timmis GC. Prevalence and significance of ventriculoatrial conduction. Pacing Clin Electrophysiol. 1984;7:784–9.
Akhtar M, Damato AN, Batsford W, Ruskin JN. A comparative analysis of anterograde and retrograde conduction patterns in man. Circulation. 1975;52:766–78.
Shenasa M, Gilbert CJ, Schmidt DH, Akhtar M. Procainamide and retrograde atrioventricular nodal conduction in man. Circulation. 1982;65:355–62.
Richter S, Muessigbrodt A, Salmas J, Doering M, Wetzel M, Arya A, et al. Ventriculoatrial conduction and related pacemaker-mediated arrhythmias in patients implanted for atrioventricular block: an old problem revisited. Int J Cardiol. 2013;168:3300–8.
Sadr-Ameli MA, Shenasa M, Lacombe P, Faugere G, Nadeau R. Effect of autonomic nervous system modulation on retrograde atrioventricular nodal conduction in the human heart. Cardiovasc Res. 1987;21:45–54.
Hariman RJ, Pasquariello JL, Gomes JA, Holtzman R, El-Sherif N. Autonomic dependence of ventriculoatrial conduction. Am J Cardiol. 1985;56:285–91.
Morady F, Nelson SD, Kou WH, Pratley R, Schmaltz S, De Buttleir M, et al. Electrophysiologic effects of epinephrine in humans. J Am Coll Cardiol. 1988;11:1235–44.
Morady F, Kou WH, Kadish AH, Toivonen LK, Kushner JA, Schmaltz A. Epinephrine-induced reversal of verapamil’s electrophysiologic and therapeutic effects in patients with paroxysmal supraventricular tachycardia. Circulation. 1989;79:783–90.
Cismaru G, Gusetu G, Muresan L, Rosu R, Andronache M, Matuz R, et al. Recovery of ventriculo-atrial conduction after adrenaline in patients implanted with pacemakers. Pacing Clin Electrophysiol. 2015;38:857–63.
Adams CW. Retrograde atrial conduction with complete heart block following implantation of an internal ventricular pacemaker. Dis Chest. 1963;43:544–5.
Castillo C, Samet P. Retrograde conduction in complete heart block. Br Heart J. 1967;29:553–8.
Hayes DL, Furman S. Atrio-ventricular and ventriculo-atrial conduction times in patients undergoing pacemaker implant. Pacing Clin Electrophysiol. 1983;6:38–46.
Touboul P, Huerta F, Delahaye JP. Retrograde conduction in complete atrioventricular block. Study using His bundle recordings. Br Heart J. 1976;38:706–11.
Josephson ME. Clinical cardiac electrophysiology: techniques and interpretation. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. p. 106–7.
Akhtar M. Retrograde conduction in man. PACE. 1981;4:548–62.
Kashani IA, Shakibi JG, Siassi B. Effect of verapamil on retrograde ventriculoatrial conduction in children. Jpn Heart J. 1980;21:485–90.
Shanasa M, Denker S, Mahmud R, Lehmann M, Murthy VS, Akhtar M. Effect of verapamil on retrograde atrioventricular nodal conduction in the human heart. J Am Coll Cardiol. 1983;2:545–50.
Reddy CP, Kuo CS. Effect of amiodarone on retrograde conduction and refractoriness of the His-Purkinje system in man. Br Heart J. 1984;51:648–53.
Dougherty AH, Rinkenberger RL, Naccarelli GV. Effect of pharmacologic autonomic blockade on ventriculoatrial conduction. Am J Cardiol. 1986;57:1274–9.
Den Dulk K, Lindemans FW, Bar FW, Wellens HJ. Pacemaker related tachycardias. Pacing Clin Electrophysiol. 1982;5:471–5.
Bathen J, Gundersen T, Forfang K. Tachycardias related to atrial synchronous ventricular pacing. Pacing Clin Electrophysiol. 1982;5:471–5.
Barold SS, Levine PA. Pacemaker repetitive nonreentrant ventriculoatrial synchronous rhythm. A review. J Interv Card Electrophysiol. 2001;5:45–58.
Barold SS. Repetitive reentrant and nonreentrant ventriculoatrial synchrony in dual chamber pacing. Clin Cardiol. 1991;14:754–63.
Bathen J, Gundersen T, Forfang K. Tachycardia related to atrial synchronous ventricular pacing. PACE. 1982;5:471–5.
Frumin H, Furman S. Endless loop tachycardia started by an atrial premature complex in a patient with dual chamber pacemaker. J Am Coll Cardiol. 1985;5:707–10.
Ausubel K, Gabry MD, Klementowicz PT, Furman S. Pacemaker-mediated endless loop tachycardia at rates below the upper rate limit. Am J Cardiol. 1988;61:465–7.
Klementowicz P, Ausubel K, Furman S. The dynamic nature of ventriculoatrial conduction. PACE. 1988;11:1917–28.
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Gabriel, G. et al. (2019). How to Induce Pacemaker-Mediated Tachycardia?. In: Cismaru, G. (eds) Arrhythmia Induction in the EP Lab. Springer, Cham. https://doi.org/10.1007/978-3-319-92729-9_21
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