Journal Article

Tachycardia after pacemaker implantation in a patient with complete atrioventricular block

Gabor Z. Duray, Carsten W. Israel, Florian T. Wegener and Stefan H. Hohnloser

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 10, pages 900-903
Published in print October 2007 | ISSN: 1099-5129
Published online May 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum079
Tachycardia after pacemaker implantation in a patient with complete atrioventricular block

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The atrioventricular (AV) node allows ante- and retrograde conduction between atria and ventricles. It is commonly assumed that these AV nodal conduction properties go hand in hand. However, ante- and retrograde AV conduction can be completely independent from each other in individual patients. We report about a patient with permanent AV block III° requiring implantation of a pacemaker. As soon as a dual-chamber device was connected to the implanted leads, a tachycardia started at the maximum tracking rate, which was subsequently reprogrammed from 120 to 170 bpm. Non-invasive electrophysiologic testing showed that this patient demonstrated 1:1 ventriculoatrial (VA) conduction up to 170 bpm leading to endless loop tachycardia (ELT) while the antegrade AV block III° persisted. This case impressively illustrates that one has to take into account that patients with antegrade AV block III° may still have a high VA conduction capacity leading to ELT. Dual-chamber devices therefore have to be programmed accordingly, activating dedicated reactions after ventricular premature beats and automatic ELT detection and termination algorithms.

Keywords: AV block; Retrograde conduction; Endless loop tachycardia; Pacemaker mediated tachycardia; Pacemaker circus movement tachycardia; Dual-chamber pacing

Journal Article.  1978 words.  Illustrated.

Subjects: Cardiovascular Medicine

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