Pacemaker-mediated tachycardia

Patient

Same patient as previous tracing; programming of the algorithm for interruption of pacemaker-mediated tachycardia;

Trace

This is the same tachycardia as in the previous tracing (PMT); it stops on one cycle and restarts on the ensuing cycle;

Trace

Analysis of the EGM allows establishing the diagnosis; initially, there is a PMT; programming of the anti-PMT algorithm (“programming successful”); diagnosis of PMT made by the device after 8 consecutive VP-AS cycles; intervention of the anti-PMT algorithm with a prolongation of the post-ventricular atrial refractory period (PVARP) to 400 ms on one cycle; atrial activity is sensed in PVARP (AR) and does not synchronize ventricular pacing; the following atrial pacing is ineffective favoring a retrograde conduction and the tachycardia restarts;

Trace

This tracing shows the interruption of the PMT after programming of the anti-PMT algorithm and an increase in the amplitude of atrial pacing (correction of the triggering factor);

Trace

EGM tracing showing the PMT interruption;

Exergue

PMT management involves the programming of a specific interruption algorithm, the programming of a PVARP longer than the retrograde conduction time (sometimes difficult because limiting in terms of monitoring atrial activity 1/1 during exercise), the prevention of episodes by suppressing triggering factors (pacing or sensing defects, oversensing, etc.).