Pacemaker Mediated Tachycardia as a Complication of the Autointrinsic Conduction Search Function

Dennis, Malcolm J.; Sparks, Paul B.

doi:10.1111/j.1540-8159.2004.00538.x

Cited by 30 publications

(15 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, previous case reports indicate the likelihood of arrhythmic incidence and inappropriate pacing caused by use of either MVP or SAV. 18,19 The present study did not observe these phenomena. A longer follow-up time is needed to address clinical outcomes provided by these two algorithms and algorithm-related adverse events.…”

Section: Discussioncontrasting

confidence: 43%

Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study

Chen

Qiu

et al. 2014

EP Europace

View full text Add to dashboard Cite

AimsThe present study was to assess the reduction of right ventricular pacing (RVP) by pacemaker algorithms of Managed Ventricular Pacing (MVP) and Search AV+ (SAV+) interval over a period of 12 months. Methods and resultsA total of 385 patients indicated for a dual-chamber pacemaker (DC-PM) were enrolled in the prospective, randomized COMPARE study at 29 centres in China between June 2009 and April 2011. Patients implanted with DC-PMs were randomized in a 1 : 1 ratio to the MVP group or the SAV+ group. The percentage of VP (%VP) was obtained from the device diagnostic data at 1-, 6-, and 12-month follow-ups and was expressed as the median %VP over all beats in patients with sinus node dysfunction (SND) and atrioventricular block (AVB) excluding persistent third-degree AVB.Of 385 enrolled patients, 253 had SND and 72 had AVB. The %VP in the MVP group was significantly lower than that in the SAV+ group at 1-, 6-, and 12-month follow-ups, respectively. At 12-month follow-up, the median %VP in SND patients was 0.20% in the MVP group and 1.4% in the SAV+ group (P , 0.0001) and the median %VP in AVB patients was 11.8% in the MVP group and 98.1% in the SAV+ group (P , 0.001). There was no statistical difference in %VP from 1-to 12-month follow-up. A trend in the correlation between %VP and AT/AF burden was observed. ConclusionOver 12-month follow-up, the %VP was lower for MVP than SAV+ in patients with either SND or AVB. The sustainable %VP reduction has potential implications in reducing the development of heart failure and/or atrial arrhythmia morbidity.--

show abstract

Section: Discussioncontrasting

confidence: 43%

Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study

Chen

Qiu

et al. 2014

EP Europace

View full text Add to dashboard Cite

show abstract

“…In qualifying patients, both treatment alternatives were well tolerated and associated with similar overall rates of adverse events. There are, however, reservations around programming DDD pacemakers with long AV intervals, since deleterious consequences such as endless loop (or pacemaker‐mediated) tachycardias and timing cycle conflicts that limit the detection of atrial tachyarrhythmias have been reported. In light of recently expressed concerns about possible proarrhythmic effects of algorithms designed to minimize ventricular pacing, it is reassuring to note that no ventricular tachyarrhythmic events were associated with the SafeR mode in the CAN‐SAVE R trial.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with intrinsic atrioventricular (AV) conduction and dual‐chamber (DDD) pacemakers, RV pacing can potentially be avoided by programming long AV delays. However, this approach is not always effective and may be associated with tachycardias and cycle timing conflicts . To address these concerns, several pacemaker algorithms were developed to minimize potentially avoidable RV pacing.…”

Section: Introductionmentioning

confidence: 99%

Very Low Ventricular Pacing Rates Can Be Achieved Safely in a Heterogeneous Pacemaker Population and Provide Clinical Benefits: The CANadian Multi‐Centre Randomised Study‐Spontaneous AtrioVEntricular Conduction pReservation (CAN‐SAVE R) Trial

Thibault

Ducharme

Baranchuk

et al. 2015

JAHA

View full text Add to dashboard Cite

BackgroundIt is well recognized that right ventricular apical pacing can have deleterious effects on ventricular function. We performed a head-to-head comparison of the SafeR pacing algorithm versus DDD pacing with a long atrioventricular delay in a heterogeneous population of patients with dual-chamber pacemakers.Methods and ResultsIn a multicenter prospective double-blinded randomized trial conducted at 10 centers in Canada, 373 patients, age 71±11 years, with indications for dual chamber DC pacemakers were randomized 1:1 to SafeR or DDD pacing with a long atrioventricular delay (250 ms). The primary objective was twofold: (1) reduction in the proportion of ventricular paced beats at 1 year; and (2) impact on atrial fibrillation burden at 3 years, defined as the ratio between cumulative duration of mode-switches divided by follow-up time. Statistical significance of both co-primary end points was required for the trial to be considered positive. At 1 year of follow-up, the median proportion of ventricular-paced beats was 4.0% with DDD versus 0% with SafeR (P<0.001). At 3 years of follow-up, the atrial fibrillation burden was not significantly reduced with SafeR versus DDD (median 0.00%, interquartile range [0.00% to 0.23%] versus median 0.01%, interquartile range [0.00% to 0.44%], respectively, P=0.178]), despite a persistent reduction in the median proportion of ventricular-paced beats (10% with DDD compared to 0% with SafeR).ConclusionsA ventricular-paced rate <1% was safely achieved with SafeR in a population with a wide spectrum of indications for dual-chamber pacing. However, the lower percentage of ventricular pacing did not translate into a significant reduction in atrial fibrillation burden.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/ Unique identifier: NCT01219621.

show abstract

“…While it is true that too frequent RVP is associated with adverse effects in cardiac function [2]- [4], unconditional elimination of RVP could be just as detrimental [17], due to potential AV decoupling/uncoupling [18], increased risk of retrograde conduction and pacemaker mediated tachycardia [19], compromised ventricular support due to nonphysiologic AV intervals [20,21], and so on. Therefore, design of RVP suppression algorithm must strike a balance between promoting intrinsic AV conduction and maintaining the AV synchrony.…”

Section: Discussionmentioning

confidence: 99%

Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Lian

Garner

Krätschmer

et al. 2009

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

View full text Add to dashboard Cite

Long term right ventricular apical pacing has been known to have adverse effects in cardiac function. The AV hysteresis (AVH) is a feature existing in many dual-chamber cardiac pacemakers that aims to minimize the right ventricular pacing, but its clinical efficacy remains inconclusive due to conflicting evidence from different studies. We have recently developed a novel integrated dual-chamber heart and pacer (IDHP) model, which can simulate various interactions between intrinsic heart activity and extrinsic cardiac pacing. In this study, we use the IDHP model to simulate various atrio-ventricular (AV) conduction pathologies, and to investigate the effects of an AVH algorithm on reducing right ventricular pacing. Our results show that the efficacy of AVH is dependent on the underlying cardiac conditions. While it can preserve intrinsic conduction during minor or moderate first degree AV block, its efficacy is reduced at higher degree AV block conditions. This pilot study further supports using the IDHP model to design and evaluate more advanced pacemaker algorithms for therapeutic interventions.

show abstract

Pacemaker Mediated Tachycardia as a Complication of the Autointrinsic Conduction Search Function

Cited by 30 publications

References 6 publications

Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study

Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study

Very Low Ventricular Pacing Rates Can Be Achieved Safely in a Heterogeneous Pacemaker Population and Provide Clinical Benefits: The CANadian Multi‐Centre Randomised Study‐Spontaneous AtrioVEntricular Conduction pReservation (CAN‐SAVE R) Trial

Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

Contact Info

Product

Resources

About