Voir la suite de cet article sur Cursus ECG
Patient
78-year-old man, implanted with a dual-chamber pacemaker for atrial disease; hospitalization for palpitations and signs of cardiac decompensation;
Trace
Pacemaker-driven tachycardia; rapid and irregular ventricular pacing (not compatible with PMT which is regular); probable atrial fibrillation;
Trace
EGM shows the sensing of a rapid and irregular atrial rhythm with permanent ventricular pacing; absence of fallback following the sensing of atrial fibrillation explaining the rapid ventricular pacing;
Exergue
A pacemaker-driven irregular tachycardia at the ventricular level and oscillating near the maximum triggering rate in a patient implanted with a dual-chamber pacemaker suggests the occurrence of atrial fibrillation and a disabled or a dysfunction of the fallback algorithm (mode switching).
The management of patients with pacemaker devices presenting atrial arrhythmia episodes is complex given the various mechanisms known to trigger atrial arrhythmias and the risk of rapid ventricular pacing when tracking a rapid atrial rhythm.