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    
Abstract/OtherAbstract:
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.
Authors:
Bernhard Strohmer; Christiana Schernthaner; Maximilian Pichler
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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    
Affiliation:
Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University, Salzburg, Austria. B.Strohmer@salk.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Flutter / epidemiology*,  prevention & control*
Causality
Comorbidity
Electric Countershock / statistics & numerical data*
Female
Heart Failure / epidemiology*,  prevention & control*
Humans
Incidence
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Assessment / methods*
Treatment Outcome

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


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