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• W4377016026 abstract "A 74-year-old man with a dual-chamber pacemaker (DC-PPM) had device interrogation revealing normal impedances, sensing, and capture thresholds. Parameters were as follows- Pulse generator: Abbott Assurity; mode DDDR; base rate: 70 bpm; maximum tracking: 105 bpm; maximum sensor: 130 bpm; Paced/Sensed AV delay: 250 ms; Auto Mode Switch: DDIR. An alert for ventricular high rate (VHR) episode with electrogram (EGM) is shown in figure 1. There is a sensed 1:1 tachyarrhythmia with cycle length about 400 ms (150 bpm) triggering automatic mode switch (AMS). Then, a blanked PAC is not sensed in the atrium but conducts and leads to a V-sensed event. This is followed by atrial pacing at about 335 ms (180 bpm), well above the maximum tracking and sensor rates. While there are many arrhythmias that can cause for VHR episodes, seeing rapid atrial pacing as a culprit may seem puzzling. To understand the mechanism for this phenomenon, one must consider how timing cycle parameters determine the pacing rate. Modern DC-PPMs use atrial-based timing where an atrial sensed or paced beat resets the AAI timer. Historically, DC-PPM used ventricular-based timing, where atrial pacing rate is determined by the calculated V-A interval known as the atrial escape interval (AEI). Atrial pacing rate is equal to the sum of the AEI plus the A-V delay. The AEI remains constant, while the A-A interval may vary. In a scenario where intrinsic AV conduction is shorter than the programmed AV delay, the effective a-paced rate can exceed the base rate or sensor rate. In our patient with an Abbott device, the transition to DDI mode due to a high atrial rate also transitioned the device to ventricular-based timing. With a PAC that fell in the blanking period, the AEI was exceeded leading to an atrial paced event, just before the PAC had conducted to the ventricle, giving the appearance of a short ‘pseudo’ AV interval of just about 60-70 ms. The AEI was then met again around 330 ms leading to another a-paced event, just before the previous a-paced event had conducted to the ventricle, and this trend of ‘pacemaker crossover’ continued with atrial pacing at the AEI with a short ‘pseudo’ AV interval. In conclusion, a perfectly timed PAC falling in the blanking period led to atrial pacing at the AEI with a short ‘pseudo’ AP-VS interval due to pacemaker crossover, which was ultimately made possible due to ventricular-based timing cycles engaged by mode switch to DDI because of the original tachyarrhythmia." @default.
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• W4377016026 date "2023-05-01" @default.
• W4377016026 modified "2023-09-26" @default.
• W4377016026 title "PO-04-020 ATRIAL PACING ABOVE THE MAX SENSOR RATE: WHAT IS THE MECHANISM?" @default.
• W4377016026 doi "https://doi.org/10.1016/j.hrthm.2023.03.1149" @default.
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