Document Detail

Blanked atrial flutter in patients with cardiac resynchronization therapy: clinical significance and implications for device programming.
MedLine Citation:
PMID:  16650264     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial arrhythmias are frequently observed in patients with heart failure and may be a primary cause for decompensation during cardiac resynchronization therapy (CRT). The accurate detection of organized atrial tachyarrhythmias poses a challenge to the function of mode-switching biventricular pacemakers/defibrillators. METHODS: The purpose of the study was to determine retrospectively the incidence of blanked atrial flutter and mode switch failure (2:1 lock-in), and to look for factors predisposing to this problem. A total number of 65 patients with CRT devices has been followed regularly over 18 +/- 12 months. Five patients were excluded because of chronic atrial fibrillation and reprogramming to VVIR mode. RESULTS: Seven out of 60 patients (12%) were diagnosed with blanked atrial flutter at unscheduled device interrogation. Sustained biventricular pacing at a median rate of 125/min-mimicking sinus tachycardia-resulted in rapid deterioration of heart failure and hospitalization. Mode switch failure occurred due to coincidence of every second flutter wave with atrial blanking. The group with 2:1 lock-in was programmed to longer atrial blanking times (143 +/- 34 ms vs 105 +/- 32 ms; P = 0.026) and AV intervals (126 +/- 8 ms vs 107 +/- 29; P = 0.001) than the group without lock-in. Other clinical characteristics examined did not differ between the two groups apart from a previous history of atrial fibrillation (P = 0.032). CONCLUSION: Blanked atrial flutter with rapid ventricular pacing is a clinically important problem in heart failure patients treated with CRT devices. Efforts should be made to avoid this complication by atrial lead implantation without ventricular farfield oversensing, by programming short PVAB and AV intervals, and by implementation of dedicated device algorithms.
Bernhard Strohmer; Christiana Schernthaner; Maximilian Pichler
Related Documents :
9547454 - Dysrhythmia update: the effect of intermittent heart block on the central venous pressu...
9165174 - P-wave morphology during right atrial pacing before and after atrial flutter ablation--...
24647294 - Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children w...
21321124 - Chronic inhibition of pyruvate dehydrogenase in heart triggers an adaptive metabolic re...
12435184 - Comparison of electrocardiogram and intrathoracic electrogram signals for detection of ...
17895124 - Emergency physician attitudes toward thrombolytic therapy in acute stroke.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  29     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-05-02     Completed Date:  2006-09-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-73     Citation Subset:  IM    
Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University, Salzburg, Austria.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Atrial Flutter / epidemiology*,  prevention & control*
Electric Countershock / statistics & numerical data*
Heart Failure / epidemiology*,  prevention & control*
Middle Aged
Retrospective Studies
Risk Assessment / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  "Torsade de pointes" in patients with structural heart disease and atrial fibrillation tre...
Next Document:  Medium-term efficacy of segmental ostial pulmonary vein isolation for the treatment of permanent and...