Pacemaker-Mediated Tachycardia Clinical Presentation

Updated: Apr 15, 2022
  • Author: Brian Olshansky, MD, FESC, FAHA, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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History and Physical Examination


Consider pacemaker-mediated tachycardia (PMT) in patients with a dual-chamber pacemaker (programmed DDD or VAT) who experience palpitations, rapid heart rates, lightheadedness, syncope, or chest discomfort. However, the majority of patients are asymptomatic.

Physical examination

The examination findings may confirm tachycardia and may be otherwise unremarkable, except for presence of a pacemaker. [7]

Findings on ECG demonstrate intermittent or continuous ventricular-paced rhythm at or near the upper rate limit, which typically is set at 120-130 bpm.

There may be cannon A waves, hypotension, or heart failure (if episodes are prolonged and incessant).