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Apparent Extension of the Atrioventricular Interval Due to Sensor‐Based Algorithm Against Supraventricuiar Tachyarrhythmias
Author(s) -
LEUNG SUMKIN,
LAU CHUPAK,
LEUNG WINGHUNG,
TAI YAUTING,
CHUNG FELSA,
CHOW YUENHA
Publication year - 1994
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1994.tb01394.x
Subject(s) - medicine , prolongation , cardiology , atrial flutter , supraventricular arrhythmia , interval (graph theory) , algorithm , atrial fibrillation , mathematics , combinatorics
Rapid ventricular tracking response to supraventricular tachyarrhythmia is one major limitation to DDD pacing. In a DDDR pacemaker, sensor‐based algorithms have been used to control these arrhythmias. These include the use of an interim rate limit (conditional ventricular tracking limit) or a separate maximum tracking and sensor rate limits (discrepant upper rate). These algorithms limit inappropriate ventricular pacing rate during tracking of pathological supraventricuiar tachyarrhythmia and atrial flutter by Wenckebach‐like prolongation of the AV interval. We observed that this may cause an unexpected extension of the AV interval in patients with high atrial rate and intact AV nodal conduction. This was due to P wave rate above the conditional ventricular tracking limit or maximum tracking limit, but AV paced interval prolongation was avoided by the occurrence of intrinsic conduction, albeit at an AV interval longer than the programmed AV interval. This might appear as failure of ventricular pacing on the ECG. This phenomenon is a modified form of “upper rate” behavior occurring in the AV interval, and should be recognized as a normal behavior rather than pacemaker malfunction.