Pacemaker-mediated reentrant arrhythmia facilitated by an atrial-tracking leadless pacemaker

Authors

Dejan Vrtikapa, Department of Medicine, Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Luke Chong, Advocate Health - MidwestFollow
Daniel Modaff, Department of Medicine, Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Ryan Kipp, Department of Medicine, Division of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Recommended Citation

Vrtikapa D, Chong L, Modaff D, Kipp R. Pacemaker-mediated reentrant arrhythmia facilitated by an atrial-tracking leadless pacemaker. J Cardiovasc Electrophysiol. Published online June 25, 2024. doi:10.1111/jce.16350

Affiliations

Aurora BayCare Medical Center

Abstract

Introduction:Pacemaker-mediated tachycardia is a known arrhythmia in patients with dual chamber pacemakers and defibrillators and intact ventriculoatrial (VA) conduction. We report a case of pacemaker-mediated reentrant arrhythmia (PMRA) in a patient with an atrioventricular (AV) synchronous leadless pacemaker.

Methods and results:A 91-year-old female presented with 2:1 AV conduction and received an AV synchronous leadless pacemaker. She had atrial mechanical sense-ventricular paced beats between heart rates of 80-100 bpm more than 80% of the time. She was found to have a new cardiomyopathy and was referred for placement of biventricular pacemaker. At the time of device implantation, her electrocardiogram showed ventricular pacing with a short RP interval and superiorly directed P waves. Changes in the ventricular pacing rate resulted in changes in the atrial rate. Following device placement, her heart rate decreased to the lower rate limit of her pacemaker. The atrial mechanical sense impulse most likely was generated by a retrograde conducted P wave resulting in near incessant PMRA.

Conclusion:PMRA may occur in patients who receive an AV synchronous leadless pacemaker with intact VA conduction and sinoatrial node dysfunction. Due to the lower rates of PMRA, this arrhythmia may be underrecognized. Interventions for and implications of PMRA need further investigation.

Document Type

Article

PubMed ID

38923693