Treatment of atypical pacemaker‐mediated tachycardia with ablation of the retrograde atrioventricular nodal pathway

Abstract

A 25-year-old runner received a single-lead, VDD pacemaker after ablation of AV nodal reentrant tachycardia complicated by intermittent AV block. The rateadaptive AV delay algorithm (RAAV), which shortens the sensed AV interval (SAV) at faster atrial rates, was programmed to provide a physiologic SAV with exercise.She developed repetitive, atypical, long-RP pacemaker-mediated tachycardia (PMT) because the RAAV shortened the antegrade SAV and retrograde conduction occurred over the slow AV nodal pathway. PMT was refractory to usual programming solutions. Using high-density electroanatomic mapping, we were able to ablate the retrograde limb of PMT without further damaging AV conduction. K E Y W O R D S cardiac mapping -3-dimensional systems, implantable devicespacemaker-bradyarrhythmias, implantable devicesphysiologic pacing

Atrioventricular Node Ablation to Enhance Resynchronization Therapy Response in a Patient With Complete Atrioventricular Block

“…AV node ablation in patients with antegrade AV block has been reported in pacemaker recipients with symptomatic PMT in which device programming options were considered inappropriate ( 3 , 4 ). To our knowledge, no previous case has been reported in which retrograde conduction did not cause clinical tachycardias, but instead a lack of response to CRT secondary to impaired AV synchrony, which could be successfully managed by AV node ablation.…”