Novel Predictor for New-Onset Atrial High-Rate Episode in Patients With a Dual-Chamber Pacemaker

Abstract Background Among patients who underwent dual chamber devices (DDD) implantation, new occurrence of atrial fibrillation (AF) is higher compared to general population. However, it is unclear which factors affect new onset AF. Previous studies reported that the prolonged P wave dispersion (PWD) in sinus rhythm could be considered as an index for progression of conduction disturbance as the arrhythmogenic state for AF. In this study, we sought to elucidate the clinical factors including PWD associated with silent atrial high rate episode (AHRE) in the population of DDD. Methods The study population consisted of 101 patients with DDD from 2010 to 2014. All patients were measured PWD at the time of implantation. AHRE was defined as any episode of sustained atrial tachyarrhythmia (>170 bpm). AHREs were evaluated during initial 1 year after the implantation. They were divided into AHRE group (n=34) and non-AHRE group (n=67) and various clinical parameters were compared. Results The mean age was 75±11 years old. The AHRE groups showed higher rate of diagnosis of sick sinus syndrome (p=0.05) and longer PWD (62.6±13.1 versus 38.2±13.9 ms, p<0.0001) in comparison with non-AHRE group. Multivariate analysis revealed that the PWD was significant independent factors for the prediction of new appearance of AHRE (OR: 1.12; 95% CI, 1.07–1.17; p<0.0001). Cut-off value for parameter was determined by ROC curves achieving highest sensitivity and specificity, 48 mm was the best point of PWD (sensitivity of 73.8%, specificity of 77.9%, AUC 0.78). ROC curve Conclusion PWD were significant predictor for new appearance of AHRE in patients with DDD.

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Dual Atrial Rhythms: A Case Report Of An Unusual Cause Of Pacemaker Syndrome

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab531 ◽

2022 ◽

Author(s):

Natee Sirinvaravong ◽

Mark Heimann ◽

Steve Liskov ◽

Gan-Xin Yan

Keyword(s):

Heart Failure ◽

Tricuspid Valve ◽

High Rate ◽

Mode Switching ◽

Dual Chamber ◽

P Waves ◽

Dual Chamber Pacemaker ◽

Automatic Mode ◽

Automatic Mode Switching ◽

Pacemaker Syndrome

Abstract Background Atrial dissociation (AD) is described as the existence of two simultaneous electrically isolated atrial rhythms. Theoretically, detection of dual atrial rhythms with a sufficiently high rate by pacemaker can lead to automatic mode switching and associated pacemaker syndrome. Such a clinical observation has not been reported before in the literature. Case Summary An 87-year-old female with Ebstein’s anomaly status post tricuspid valve annuloplasty and tricuspid valve replacement and a dual chamber pacemaker presented with congestive heart failure one week after undergoing atrial lead revision. Interrogation of her dual chamber pacemaker revealed two atrial rhythms: sinus or atrial-paced rhythm and electrically isolated atrial tachycardia (AT). Sensing of both atrial rhythms by the pacemaker led to automatic mode switching, which manifested as ventricular paced rhythm with retrograde P waves on electrocardiogram (ECG). Adjusting the atrial lead sensitivity to a level higher than the sensing amplitude of AT restored atrial paced and ventricular sensed rhythm, which resulted in resolution of heart failure symptoms. Discussion Regardless of the cause of AD, there must be electrical insulation between the two rhythms for their independent coexistence in the atria. AD can lead to pacemaker syndrome from automatic mode switching. If the sensing amplitude during sinus rhythm is significantly larger than that of AT, adjusting the atrial lead sensitivity would solve the issue, as in the present case. Otherwise, atrial lead revision, pharmacotherapy or AT ablation should be considered.

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High Rate Episodes in a Dual Chamber Pacemaker: What is the Mechanism?

Pacing and Clinical Electrophysiology ◽

10.1111/pace.14430 ◽

2021 ◽

Author(s):

VIJAY SHEKAR P ◽

VICKRAM VIGNESH RANGASWAMY ◽

MUTHIAH SUBRAMANIAN ◽

AURAS RAVI ATREYA ◽

SACHIN YALAGUDRI ◽

...

Keyword(s):

High Rate ◽

Dual Chamber ◽

Dual Chamber Pacemaker

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Olmesartan Reduces New-onset Atrial Fibrillation and Atrial Fibrillation Burden after Dual-chamber Pacemaker Implantation in Atrioventricular Block Patients

Chinese Medical Journal ◽

10.4103/0366-6999.189924 ◽

2016 ◽

Vol 129 (18) ◽

pp. 2143-2148 ◽

Cited By ~ 1

Author(s):

Hang Zhang ◽

Chang Pan ◽

Juan Zhang ◽

Lin-Lin Zhu ◽

Kai Huang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrioventricular Block ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Atrial Fibrillation Burden ◽

Onset Atrial Fibrillation ◽

New Onset

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Sinus node dysfunction associates with atrial high-rate episodes after DDD pacemaker implantation

10.21203/rs.2.12973/v1 ◽

2019 ◽

Author(s):

Qi Xue ◽

Hai Zou ◽

Lihong Wang ◽

Hong Shao ◽

Yuan Ma

Keyword(s):

Atrial Fibrillation ◽

Sinus Node ◽

Pacemaker Implantation ◽

Structural Heart Disease ◽

Sinus Node Dysfunction ◽

High Rate ◽

Atrial Pacing ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Increased Risk

Abstract Background： Patients implanted with pacemakers frequently develop atrial fibrillation. Pacemaker-detected atrial high-rate episodes or AHREs, where one AHRE is defined as ≥ 160beats/min lasting ≥ 5 minutes, may identify patients at increased risk for stroke and death. In this study, we sought to observe whether patients with sinus node dysfunction or atria-ventricular block are more likely to develop AHREs. Methods: A total of 103 patients (age 69.4±13.5 years，58% female) with DDD/DDDR pacemakers were enrolled for the study. These pacemakers were equipped with features that enabled the detection and storage of information such as the dates, durations and sequential episodes of AHRE. Patients were followed up for 2 years and the time of the first occurrence of AHRE was determined at follow-up visit. Other data such as age, gender, structural heart disease, concomitant non-cardiac diseases, the cumulative percentage of atrial pacing (Cum% AP) and ventricular pacing (Cum% VP) were also collected. Results: Atrial fibrillation developed frequently after the dual-chamber pacemaker implantation. AHRE occurred more often in patients with sinus node disease (SND) than those with atrioventricular block (AVB) （OR, 2.553; 95%CI, 1.122-5.814；P=0.045）. Conclusions: AHRE developed frequently after dual-chamber pacemaker implantation. Patients with SND are more likely to develop AF compared to the patients with AVB.

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Symptomatic Trifascicular Block in Steinert’s Disease: Is It Too Soon for a Pacemaker?

Case Reports in Cardiology ◽

10.1155/2016/6372181 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Glenmore Lasam ◽

Roberto Roberti ◽

Gina LaCapra ◽

Roberto Ramirez

Keyword(s):

Atrioventricular Block ◽

Right Bundle Branch Block ◽

Dual Chamber ◽

Bundle Branch Block ◽

Dual Chamber Pacemaker ◽

Steinert's Disease ◽

Steinert’S Disease ◽

New Onset

We report a case of a 62-year-old male with Steinert’s disease who presented with progressive intermittent episodes of lightheadedness five years after he was diagnosed with the disease. On evaluation, he developed a new onset trifascicular block (first degree atrioventricular block, new onset right bundle branch block, and left anterior fascicular block). A dual chamber pacemaker was inserted and lightheadedness improved significantly.

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