Document Detail

A novel mechanism of failure to detect atrial arrhythmias by pacemakers and implantable cardioverter defibrillators.
MedLine Citation:
PMID:  19682166     Owner:  NLM     Status:  MEDLINE    
A 64-year-old man with complete heart block, status post-Medtronic dual chamber pacemaker insertion, failed ablation for atrial tachycardia at an outside institution. Despite persistent palpitations and known unsuccessful ablation, pacemaker interrogation revealed no evidence of atrial arrhythmias. At electrophysiology study, burst pacing from the high right atrium and distal coronary sinus at 370 ms revealed bidirectional 2:1 interatrial conduction block. Left atrial burst pacing at 260 ms induced an atrial tachycardia (cycle length 340 ms) with 2:1 left to right atrial block and right atrial activation at 680 ms. The tachycardia was localized to the lateral left atrial roof. A series of ablation lesions from left to right superior pulmonary vein terminated the tachycardia. Left to right interatrial conduction block is a mechanism for underdetection of atrial arrhythmias with implantable devices not previously described. As the extent of atrial ablation increases, the incidence of this mechanism of underdetection may increase. Though devices are often considered ideal for atrial arrhythmia detection and are used in multiple trials, detection failures can occur despite appropriate device function. This case underscores the need for electrocardiographic monitoring in addition to device-based electrogram monitoring.
Emily Rose; Larry A Chinitz; Douglas S Holmes; Anthony Aizer
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-08-11
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  325-8     Citation Subset:  IM    
Cardiovascular Division, Department of Internal Medicine, New York University, New York, New York 10016, USA.
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MeSH Terms
Atrial Fibrillation / diagnosis*
Defibrillators, Implantable*
Electrocardiography, Ambulatory / instrumentation*
Equipment Failure*
Equipment Failure Analysis
Middle Aged
Pacemaker, Artificial*

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

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