Document Detail

Maintenance of atrioventricular sequence after His-bundle ablation for paroxysmal supraventricular rhythm disorders: a unique use of the fallback mode in dual chamber pacemakers.
MedLine Citation:
PMID:  1708870     Owner:  NLM     Status:  MEDLINE    
The usual mode of controlling ventricular rate after His-bundle ablation is placement of a ventricular demand rate responsive pacemaker. Atrioventricular synchrony is therefore lost in individuals whose atrial rhythm disturbances are paroxysmal. Thirty-seven His ablations were performed at this institution, since January of 1983, for atrial rhythm disturbances that were not suppressible with medical therapy alone. Of those, ten patients were identified whose atrial rhythm disturbances were intermittent and who would otherwise benefit by having proper atrioventricular sequence during sinus rhythm. These patients underwent placement of a dual chamber pacemaker system having a fallback mode. At a mean follow-up period of 17 +/- 11 months, eight patients continued to maintain proper atrioventricular sequence with ventricular pacing tracking atrial activation during sinus rhythm. Supraventricular tachyarrhythmic attacks were associated with attainment of the programmed upper rate limit at which time the fallback mode was activated and the pacemaker automatically converted to a ventricular demand (VVI) mode. Restoration of normal sinus rhythm was associated with restoration of proper atrioventricular sequence. Two patients have developed chronic atrial fibrillation and their pacemakers continue to function in the fallback mode as VVI devices. In conclusion, intermittent supraventricular tachyarrhythmias which are resistant to drug therapy can be treated with His ablation and dual chamber pacing utilizing special pacemaker features such as the fallback mode.
G Van Wyhe; J Sra; K Rovang; C Gilbert; M Akhtar; P Tchou
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  14     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1991 Mar 
Date Detail:
Created Date:  1991-06-04     Completed Date:  1991-06-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  410-4     Citation Subset:  IM    
University of Wisconsin, Sinai Samaritan Medical Center, Milwaukee 53201.
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MeSH Terms
Bundle of His*
Cardiac Pacing, Artificial / methods*
Heart Conduction System / physiopathology*
Pacemaker, Artificial
Tachycardia, Supraventricular / physiopathology,  therapy*

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