Pacemakers can be directly involved in initiating or sustaining different forms of arrhythmia. These can cause symptoms such as dyspnea, palpitations, and decompensated heart failure. Early detection of these arrhythmias and optimal pacemaker programming is pivotal. The aim of this review article is to summarize the different types of pacemaker‐mediated arrhythmias, their predisposing factors, and mechanisms of prevention or termination.
Junctional Ectopic Tachycardia (JET) is a tachyarrhythmia arising from the atrioventricular node and His bundle area. It is also called junctional tachycardia, focal junctional tachycardia, or junctional nonreentrant tachycardia. Heart rate in JET should be more than 95 th percentile of heart rate for age (typically more than 100 beats per minute in adults); otherwise, it is called accelerated junctional rhythm. 1-3 JET is more common in children and may be congenital or acquired in postoperative settings. JET is a rare arrhythmia in adults and the pathogenesis is not completely understood. Moreover, because its clinical and electrocardiographic presentation varies, the diagnosis is challenging, and it can be easily mistaken for more common arrhythmias like atrioventricular nodal reentrant tachycardia (AVNRT). 1,4-5 2 | CLINI C AL FE ATURE S This arrhythmia can be categorized as primary JET, without a clear predisposing factor, or secondary JET, which occurs in a clinical condition. Primary JET occurs as congenital form or as sporadic cases in children and adults. Congenital JET occurs within the first 6 months of age, usually presents at birth, and is associated with high morbidity and mortality. It is an arrhythmia with mean ventricular rates of 200 to 250 beats/min and is associated with a high incidence of ventricular systolic dysfunction and clinical heart failure. Prenatal cases may present with hydrops. 1 When it occurs after the age of 6 months, the clinical course is not malignant. Indeed, a similar clinical course to other supraventricular tachycardias has been reported in adults and the main symptom in these patients is palpitations with exacerbation during physical
Ectopic foci arising from pulmonary veins (PVs) are the predominant sources for the initiation and maintenance of atrial fibrillation (AF) in a vast majority of cases. However, ectopic foci also exist in the non-PV areas like superior vena cava (SVC) in 10-20% of the cases. We report the significance of SVC isolation in a patient with persistent AF and anomalous pulmonary venous connection of the right superior pulmonary vein into the SVC.
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