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Orthodromic Pacemaker‐Mediated Tachycardia in a Biventricular System Without an Atrial Electrode
Author(s) -
BERRUEZO ANTONIO,
MONT LLUIS,
SCALISE ANDREA,
BRUGADA JOSEP
Publication year - 2004
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2004.03676.x
Subject(s) - medicine , orthodromic , cardiology , tachycardia , ventricle , atrium (architecture) , anesthesia , atrial fibrillation , electrophysiology
Pacemaker‐mediated tachycardia is a well‐known complication of dual‐chamber devices. In this report, we describe for the first time a case of orthodromic pacemaker‐mediated tachycardia in a patient in whom a biventricular system without an atrial electrode had been implanted. Retrograde atrial activation was directly produced by the dislodged coronary vein electrode in the AV groove, resulting in simultaneous capture of the left atrium and left ventricle. During tachycardia, AV nodal conduction was via the anterograde pathway of the circuit and limited the ventricular response. Subsequently, right ventricular activation was sensed by the right ventricular electrode that triggered biventricular pacing and left atrial capture, perpetuating the tachycardia. Because the left atrial threshold was higher than the left ventricular threshold, the problem could be resolved easily by lowering the output of the coronary vein electrode.