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Pacemaker-Mediated Tachycardia Follow-up

  • Author: Brian Olshansky, MD; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Sep 16, 2014
 

Further Inpatient Care

Once adequate measures are taken to eliminate PMT, inpatient care is not necessary.

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Deterrence/Prevention

See Medical Care.

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Complications

PMT rarely is associated with any serious complications such as presyncope or syncope.

In many patients, the condition may be asymptomatic and is noted only with ECG or Holter monitoring.

With the appropriate programming interventions described above, the problem usually is resolved, and, in most modern pacemakers, it can be detected and treated by the device itself.

In patients who develop chest pain (angina pectoris) associated with the rapid pacing rate, consider a stress test to evaluate for coronary artery disease.

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Prognosis

Prognosis is not directly altered by an episode of PMT and is defined by the patient's underlying cardiac or medical condition.

Indirectly, in a rare event such as PMT-induced syncope, a patient could sustain injury as a result of the syncope.

Persistent PMT can cause hypotension and heart failure symptoms.

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Contributor Information and Disclosures
Author

Brian Olshansky, MD Professor Emeritus of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society, Cardiac Electrophysiology Society, American Heart Association

Disclosure: Received honoraria from Guidant/Boston Scientific for speaking and teaching; Received honoraria from Medtronic for speaking and teaching; Received consulting fee from Guidant/Boston Scientific for consulting; Received consulting fee from BioControl for consulting; Received consulting fee from Boehringer Ingelheim for consulting; Received consulting fee from Amarin for review panel membership; Received consulting fee from sanofi aventis for review panel membership.

Coauthor(s)

Noel G Boyle, MB, BCh, MD, PhD Professor of Medicine, UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center

Noel G Boyle, MB, BCh, MD, PhD is a member of the following medical societies: American College of Cardiology, European Society of Cardiology, Heart Rhythm Society, American College of Physicians

Disclosure: Nothing to disclose.

Chirag M Sandesara, MD Virginia Cardiovascular Associates, Cardiac Rhythm Care

Chirag M Sandesara, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Rakesh Gopinathannair, MD, MA Director of Cardiac Electrophysiology, University of Louisville; Assistant Professor of Medicine, Division of Cardiovascular Medicine, University of Louisville School of Medicine

Rakesh Gopinathannair, MD, MA is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society

Disclosure: Received consulting fee from St. Jude Medical for consulting; Received honoraria from Boston Scientific for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America

Disclosure: Nothing to disclose.

References
  1. Love CJ. Pacemaker Troubleshooting and Follow-Up. Ellenbogen KA, Kay GN, Lau CP, Wilkoff BL, eds. Clinical Cardiac Pacing Defibrillation and Resynchronization Therapy. 3rd Ed. Philadelphia, PA: Elsevier; 2007. 1005-1062.

  2. Richter S, Muessigbrodt A, Salmas J, Doering M, Wetzel U, Arya A, et al. Ventriculoatrial conduction and related pacemaker-mediated arrhythmias in patients implanted for atrioventricular block: an old problem revisited. Int J Cardiol. 2013 Oct 9. 168(4):3300-8. [Medline].

  3. Frumin H, Furman S. Endless loop tachycardia started by an atrial premature complex in a patient with a dual chamber pacemaker. J Am Coll Cardiol. 1985 Mar. 5(3):707-10. [Medline].

  4. Greenspon AJ, Greenberg RM, Frankl WS. Tracking of atrial flutter during DDD pacing: another form of pacemaker-mediated tachycardia. Pacing Clin Electrophysiol. 1984 Nov. 7(6 Pt 1):955-60. [Medline].

  5. Rozanski JJ, Blankstein RL, Lister JW. Pacer arrhythmias: myopotential triggering of pacemaker mediated tachycardia. Pacing Clin Electrophysiol. 1983 Jul. 6(4):795-7. [Medline].

  6. Griffin J, Smithline H, Cook J. Runaway pacemaker: a case report and review. J Emerg Med. 2000 Aug. 19(2):177-81. [Medline].

  7. Klementowicz PT, Furman S. Selective atrial sensing in dual chamber pacemakers eliminates endless loop tachycardia. J Am Coll Cardiol. 1986 Mar. 7(3):590-4. [Medline].

  8. Fröhlig G, Schwerdt H, Schieffer H, Bette L. Atrial signal variations and pacemaker malsensing during exercise: a study in the time and frequency domain. J Am Coll Cardiol. 1988 Apr. 11(4):806-13. [Medline].

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Telemetered ECG tracing with surface lead II (top) and intracardiac electrograms (atrial electrogram [center] and ventricular electrogram [lower]) and marker channel (bottom) showing pacemaker-mediated tachycardia (PMT). The intracardiac markers indicate that the retrograde P waves, labeled AS for atrial-sensed event, occur 280 milliseconds after the ventricular-paced beats, labeled VP.
Telemetered ECG tracing showing atrioventricular (AV)–paced rhythm at 60/min after termination of the pacemaker-mediated tachycardia (PMT). The tracing, from top to bottom, shows lead II, atrial electrogram, ventricular electrogram, and marker channels. The intracardiac markers indicate the rhythm is atrial paced (AP) and ventricular paced (VP). Note that the VP beats are ventricular pseudofusion beats.
This is a typical example of PMT with ventricular pacing at maximum tracking rate (VP-MT) and then termination of the tachycardia as the atrial sensing (AS) is in the PVARP. This is due to PVARP extension, which is a feature of this particular pacemaker. The solid line indicates where PMT is detected and this is the point at which PVARP extension occurs. As this electrogram was detected, but not sensed to be acted upon, the ventricular tracking stopped and the tachycardia terminated. In some cases, pacemakers have a program to lengthen the PVARP after PMT detection to potentially stop the tachycardia. Alternatively, prevention of one ventricular paced beat can also stop the tachycardia. Some pacemakers use this algorithm.
 
 
 
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