A rare case of pacemaker mediated tachycardia caused by intrinsic conduction search function of a dual chamber pacemaker

• Published in: Journal of electrocardiology Vol. 69; pp. 71 - 73
• Main Authors: Almidani, Ghaith, McIntyre, William F., Long, Laurene, Divakaramenon, Syamkumar
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2021; Elsevier Science Ltd
• Subjects: Atrioventricular delay, PPM, tachycardia; Cardiac arrhythmia; Cardiac Pacing, Artificial; Defibrillators; Electrocardiography; Heart failure; Heart Rate; Humans; Intrinsic conduction search; Pacemaker, Artificial; Pacemakers; PMT; Tachycardia; Intrinsic conduction search; PMT; Atrioventricular delay, PPM, tachycardia
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2020.08.021

Pacemaker-mediated tachycardia (PMT) is a well-described cause of tachyarrhythmia in patients with dual chamber pacemakers (Barold, 1991 [1]). PMT is usually caused by common triggers including premature ventricular or atrial complexes (Alasti et al., 2018 [2]). However, PMT can also be triggered by other uncommon mechanisms. Intrinsic conduction search function is a feature available in some dual chamber permanent pacemakers that periodically looks for intrinsic conduction by gradually prolonging the preprogrammed AV delay in an attempt to minimize ventricular pacing (Calvi et al., 2017; Pakarinen and Toivonen, 2013 [3,4]). Here, we report a rare case of PMT triggered by intrinsic conduction search function.
•This case illustrates the importance of ruling out PMT in patients who develop new tachycardia after dual chamber pacemaker implantation.•When PMT is identified, knowing the trigger is crucial to appropriately manage the tachycardia either by changing device programming or adjusting medications.•Intrinsic conduction delay function of dual chamber pacemaker should be considered among potential etiologies of a new onset PMT.