{"id":327,"date":"2025-07-14T14:16:21","date_gmt":"2025-07-14T14:16:21","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=327"},"modified":"2026-01-06T20:46:18","modified_gmt":"2026-01-06T20:46:18","slug":"pacemaker-mediated-tachycardia","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/pacemaker\/pacemaker-mediated-tachycardia\/","title":{"rendered":"La tachycardie r\u00e9entrante \u00e9lectronique (TRE)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"327\" class=\"elementor elementor-327\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8d7133b e-con-full e-flex e-con e-parent\" data-id=\"8d7133b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7aac51f elementor-widget elementor-widget-heading\" data-id=\"7aac51f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pacemaker mediated tachycardia<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5ffbe05 e-con-full e-flex e-con e-parent\" data-id=\"5ffbe05\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cffe8a2 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"cffe8a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h3&quot;,&quot;h4&quot;,&quot;h5&quot;,&quot;h6&quot;],&quot;exclude_headings_by_selector&quot;:[],&quot;no_headings_message&quot;:&quot;No headings were found on this page.&quot;,&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;fas fa-circle&quot;,&quot;library&quot;:&quot;fa-solid&quot;,&quot;rendered_tag&quot;:&quot;&lt;svg class=\\&quot;e-font-icon-svg e-fas-circle\\&quot; viewBox=\\&quot;0 0 512 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&quot;},&quot;minimize_box&quot;:&quot;yes&quot;,&quot;minimized_on&quot;:&quot;tablet&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tContent\t\t\t<\/h4>\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__cffe8a2\" aria-expanded=\"true\" aria-label=\"Ouvrir la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__cffe8a2\" aria-expanded=\"true\" aria-label=\"Fermer la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div id=\"elementor-toc__cffe8a2\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<svg class=\"elementor-toc__spinner eicon-animation-spin e-font-icon-svg e-eicon-loading\" aria-hidden=\"true\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M500 975V858C696 858 858 696 858 500S696 142 500 142 142 304 142 500H25C25 237 238 25 500 25S975 237 975 500 763 975 500 975Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7449f0d e-con-full e-flex e-con e-parent\" data-id=\"7449f0d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7ae8b31 elementor-widget elementor-widget-heading\" data-id=\"7ae8b31\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">General information<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-db8708a e-con-full e-flex e-con e-parent\" data-id=\"db8708a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e7f2be5 elementor-widget elementor-widget-text-editor\" data-id=\"e7f2be5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Starting, maintaining and frequency of an PMT<\/h6><p>Starting an PMT involves :<\/p><ul><li>programming an atrial monitoring mode (DDD or VDD)<\/li><li>permeability of retrograde conduction<\/li><li>momentary or permanent loss of atrio-ventricular synchronization. If ventricular activity is correctly synchronized with atrial activity, retrograde conduction is blocked.<\/li><\/ul><p>Retrograde conduction is present in an average of 40% of patients stimulated at rest, for all indications combined. It is much more frequent in patients implanted for sinus dysfunction (up to 80%) than for atrioventricular block.<\/p><p>During exercise, the average incidence is 75%. These figures are sufficiently high to justify systematically programming effective protection.<\/p><p>The following events may favour AV dissociation, retrograde conduction and the triggering of an PMT:<\/p><ul><li>ventricular extrasystole (most frequent cause);<br \/>atrial extrasystole with prolonged AV delay to meet<\/li><li>maximum programmed heart rate;<br \/>programmed AV delay too long (the nodo-hissian pathway is out of its refractory period at the time of<\/li><li>ventricular pacing);<br \/>external interference or myopotentials detected by the atrial chain;<\/li><li>a defect in atrial detection or pacing;<\/li><li>a lack of PVARP extension after magnet removal, or fold exit during AV 1\/1 reassociation;<\/li><li>application and removal of a magnet;<\/li><li>programming of VDD mode in a patient with sinus rhythm slower than the programmed minimum frequency;<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-896e094 elementor-widget elementor-widget-image\" data-id=\"896e094\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_tre_1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NjczNiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNlwvMDFcL3BtXzE5X3NpdHVhdGlvbnNfdHJlXzEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"729\" height=\"994\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_1.png\" class=\"attachment-large size-large wp-image-6736\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_1.png 729w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_1-220x300.png 220w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_1-9x12.png 9w\" sizes=\"(max-width: 729px) 100vw, 729px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8f75b47 elementor-widget elementor-widget-text-editor\" data-id=\"8f75b47\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Maintenance of the PMT results from the detection, outside refractory periods, of a retrograde P&#8217; wave, which triggers an often lengthened AV delay that favors retrograde conduction again after ventricular stimulation. An PMT is therefore a repetitive sequence in which the pacemaker reacts to each retrograde P&#8217; wave by pacing the ventricle at a high frequency, which in turn generates a retrograde P&#8217; wave.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f4d0df7 elementor-widget elementor-widget-image\" data-id=\"f4d0df7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_tre_2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NjczNSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNlwvMDFcL3BtXzE5X3NpdHVhdGlvbnNfdHJlXzIucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"690\" height=\"377\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_2.png\" class=\"attachment-large size-large wp-image-6735\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_2.png 690w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_2-300x164.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_2-18x10.png 18w\" sizes=\"(max-width: 690px) 100vw, 690px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a726322 elementor-widget elementor-widget-text-editor\" data-id=\"a726322\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The cycle repeats itself indefinitely, unless a retrograde block occurs or a specific pacemaker algorithm intervenes.<\/p><p>Prolonged PMT can be difficult to tolerate, with symptoms ranging from a simple feeling of discomfort or palpitations to cardiac decompensation in patients with underlying heart disease.<\/p><p>Heart rate during PMT depends on :<\/p><ul><li>retrograde conduction time<\/li><li>programmed maximum frequency<\/li><li>current AV delay<\/li><\/ul><p>If the sum of retrograde conduction time + AV delay (at maximum frequency) is shorter than the minimum pacing interval (60000\/maximum frequency), the PMT frequency is equal to the programmed maximum frequency, and the AV delay is stable and lengthened with each cycle.<\/p><p>If the sum of retrograde conduction time + AV delay (at PMT\u00a0frequency) is longer than the minimum stimulation interval (60000\/maximum frequency), the PMT\u00a0frequency is lower than the maximum frequency and equal to 60000\/(RCT + AV delay), and the AV delay is that programmed at the current frequency. This situation occurs in around 35% of cases.<\/p><h6>Preventing the onset of PMT<\/h6><p>Various complementary options can be used to prevent the onset of PMT:<\/p><ul><li>programming a mode without atrial tracking, such as DDI, to prevent the onset of PMTs. However, this pacing mode has limitations that are incompatible with the characteristics of certain patients (no monitoring of detected P waves).<\/li><li>programming a PVARP longer than the retrograde conduction time that can be measured at the time of implantation. It should be borne in mind, however, that programming a PVARP\u00a0that is too long can lead to the appearance of 2:1 exercise block, which is poorly tolerated by the patient. Programming an adaptable PVARP and\/or AV delay increases exercise capacity. A PVARP programmed at 300 ms is sufficient in the majority of patients to avoid the onset of an PMT.<\/li><li>avoid any situation favoring a loss of AV synchronism:<\/li><li>program short rather than long AV delays<\/li><li>ensure correct, permanent detection and pacing (sufficient margin)<\/li><li>program bipolar atrial detection to avoid detection of myopotentials or external interference<br \/>automatically extend PVARP\u00a0on magnet withdrawal, noise reversal output, fallback output, parameter programming<\/li><li>automatically extend PVARP\u00a0after an PVC: the aim is to prevent tracking of retrograde P&#8217; waves (or sinus activity) generated by ventricular extrasystoles.<\/li><li>Retrograde conduction following an PVC can disrupt AV synchrony and affect pacing mode timing. The stimulator defines an PVC as any detected ventricular event that follows another stimulated, refractory or detected ventricular event without an intervening atrial event.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5837ab3 elementor-widget elementor-widget-image\" data-id=\"5837ab3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_tre_3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NjczNCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNlwvMDFcL3BtXzE5X3NpdHVhdGlvbnNfdHJlXzMucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"714\" height=\"338\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_3.png\" class=\"attachment-large size-large wp-image-6734\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_3.png 714w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_3-300x142.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_3-18x9.png 18w\" sizes=\"(max-width: 714px) 100vw, 714px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-62c7327 elementor-widget elementor-widget-text-editor\" data-id=\"62c7327\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Diagnosis of an PMT by the pacemaker<\/h6>\n<p>The mode of diagnosis of an PMT varies from company to company, but is based on the repetition over several cycles of atrial detection and ventricular pacing with a high frequency and fixed VP-AS coupling.<\/p>\n<h6>PMT intervention<\/h6>\n<p><span style=\"font-size: 1rem;\">PMT<\/span><span style=\"font-size: 1rem;\">&nbsp;<\/span>interruption algorithms vary from manufacturer to manufacturer. Most often, once the diagnosis of PMT is suspected, the pacemaker temporarily lengthens the PVARP so that the next atrial event is detected in the refractory period. This refractory event is not synchronized to the ventricle for 1 cycle, and the tachycardia is interrupted.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5cd647 elementor-widget elementor-widget-image\" data-id=\"d5cd647\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_tre_4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NjczMywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNlwvMDFcL3BtXzE5X3NpdHVhdGlvbnNfdHJlXzQucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"520\" height=\"274\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_4.png\" class=\"attachment-large size-large wp-image-6733\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_4.png 520w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_4-300x158.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/01\/pm_19_situations_tre_4-18x9.png 18w\" sizes=\"(max-width: 520px) 100vw, 520px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Pacemaker mediated tachycardia Content General information Starting, maintaining and frequency of an PMT Starting an PMT involves : programming an atrial monitoring mode (DDD or VDD) permeability of retrograde conduction momentary or permanent loss of atrio-ventricular synchronization. If ventricular activity is correctly synchronized with atrial activity, retrograde conduction is blocked. Retrograde conduction is present in [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-327","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pacemaker Mediated Tachycardia (PMT) | Cardiocases<\/title>\n<meta name=\"description\" content=\"Pacemaker mediated tachycardia (PMT) \u2014 causes, ECG recognition, prevention programming &amp; real device tracings.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/pacemaker\/pacemaker-mediated-tachycardia\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" 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