대상 결과 Table 1. Charateristics of study patients Pt. Age/sex Diagnosis Pacemaker Mode 1 78/M SND BIOTRONIK PHYSIOS TC 01 DDD 2 60/M SND BIOTRONIK PHYSI

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1 Case Reports Korean Circulation J 2000;303: Pacemaker-Mediated Tachycardia 3 례의임상적고찰 이계원 조정휘 김우식 강흥선 김권삼 송정상 배종화 Three Cases of Pacemaker-Mediated Tachycardia Kae Won Lee, MD, Chung Whee Choue, MD, Woo Sik Kim, MD, Heung Sun Kang, MD, Kwon Sam Kim, MD, Jung Sang Song, MD and Jong Hoa Bae, MD Division of Cardiology, Department of Internal Medicine, College of medicine, Kyung Hee University, Seoul, Korea ABSTRACT Pacemaker-mediated tachycardia PMT is a well-known complication of dual-chamber pacemaker with atrioventricular sensing and pacing DDD or atrial synchronous, ventricular demand pacemaker VDD. PMT usually starts with sensing a retrograde P waves linked to ventricular extrasystole with retrograde ventriculoatrial conduction and forms reentrant or circus movement tachycardia with the pacemaker itself as an antegrade limb and the conducting tissue of the heart as a retrograde limb. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventri-culoatrial conduction. We report two cases of PMT in 78 year-old man and 60 year-old man who received DDD type pacemakers due to sick sinus syndrome, and a case of PMT in 69 year-old man who had suffered complete heart block and received a VDD type pacemaker. In these cases, we investigate symptoms, mechanism of PMT, programed parameters of pacemaker and treatments of PMT. Korean Circulation J 2000;303: KEY WORDPacemaker-mediated tachycardia. 서 론 334

2 대상 결과 Table 1. Charateristics of study patients Pt. Age/sex Diagnosis Pacemaker Mode 1 78/M SND BIOTRONIK PHYSIOS TC 01 DDD 2 60/M SND BIOTRONIK PHYSIOS TC 01 DDD 3 69/M CHB MEDTRONIC THERA 8968i VDD SNDsinus node dysfunction, CHBcomplete heart block 335

3 Fig. 1. PMT of case hour Holter monitoring A and its schematic diagram B show atrial capture failure arrow and initiation of PMT. BIOTRONIK PHYSIONS TC 01, DDD, URL140 bpm, LRL60 bpm, AVD225 msec, PVARP200 msec, PMT rate136 bpm, PMT intervention On, AVD atrioventricular delay, LRL lower rate limit, URLupper rate limit, PVARPpostventricular atrial refractory period, Asatrial sensed, Apatrial paced, Vpventricular paced, VACTventriculoatrial conduction time. 336 Fig. 2. PMT of case hour Holter monitoring A and its schematic diagram B show atrial oversensing star and initiation of PMT. BIOTRONIK PHYSIONS TC 01, DDD, URL130 bpm, LRL60 bpm, AVD225 msec, PVARP175 msec, PMT rate120 bpm, PMT interventionoff, AVDatrioventricular delay, LRL lower rate limit, URL upper rate limit, PVARP postventricular atrial refractory period, Asatrial sensed, Apatrial paced, Vpventricular paced, VACT ventriculoatrial conduction time, As atrial oversensing. 고 안 Korean Circulation J 2000;303:

4 Table 2. Pacemaker settings and PMT data pt. AVD ms PVARP ms VACT ms URL PMT CL ms Rate bpm CL ms Rate bpm AVDatrioventricular delay, CLcycle length, PMTpacemaker-mediated tachycardia, PVARPpostventricular atrial refractory period, URLupper rate limit, VACTventriculoatrial conduction time Fig. 3. PMT of case 3. ECG during PMT attack A and its schematic diagram B show endless-loop tachycardia which was initiated by retrograde conduction arrow to atria. MEDTRONIC THERA 8968i VDD, URL 150 bpm, LRL60 bpm, AVD120 msec, PVARP270 msec, Atrial sensing0.5 mv, PMT rate130 bpm, AVD atrioventricular delay, LRL lower rate limit, URLupper rate limit, PVARPpostventricular atrial refractory period, Asatrial sensed, Apatrial paced, Vpventricular paced, VACTventriculoatrial conduction time. 337

5 결 중심단어 REFERENCES 1) Barold SS, Zipes DP. Cardiac pacemakers and antiarrhythmic devices. In Brounwald E, editor. Heart disease A textbook of cardiovascular medicine. 5th ed. Philadelphia WB Saunders Company1997. p ) Raul DM, Robert JM, Agustin C. Cardia pacemakers. In R Wayne A, Robert CS, Valentin F, editor. Hurst s the Heart. 9th ed. New York Mc Graw Hill1998. p ) Barold SS. Pacemaker induced repetitive nonreentrant ventriculo-atrial synchronyinitiation and termination by ventricular extrasystole. PACE ) Nitsche R, Gueunoun M, Lamaison D, Lascault G, Pioger G, Richard M, et al. Endless-loop tachycardias 론 Description and first clinical results of a new fully automatic protection algorithm. PACE ) Mechelen RV, Ruiter J, Vanderkerckhove Y, Boer HD, Hagemeijer F. Prevalence of retrograde conduction in heart block after DDD pacemaker implantation. Am J Cardiol ) Buckingham TA, Janosick DL, Pearson AC. Pacemaker hemodynamics Clinical implications. Progress in Cardiovascular Diseases ) Lau CP, Tai YT, Fong PC, John PSL, Chung FLW, Song S. The use of implantable sensors for the control of pacemaker mediate tachycardias A comparative evaluation of between minute ventilation sensing and acceleration sensing dual chamber rate adaptive pacemakers. PACE ) Gross JN, Moser S, Bened ZM, Firman S. DDD pacing mode survival in patients with a dual-chamber pacemaker. J Am Coll Cardiol ) Littleford PO, Curry RC Jr, Schwartz KM, Pepine CJ. Pacemaker-mediated tachycardias. A rapid bedside technique for induction and observation. Am J Cardiol ) Ibrahim B, Sanderson JE, Wright B, Palmer B. Dual chamber pacing: How many patients remain in DDD mode over the long term? Br Heart J ) Limousin M, Bonnet JL, Investigators of the Multicenter Study. A New algorithm to solve endless loop tachycardia in DDD pacing A Multi-center study of 91 patients. PACE ) Sermasi S, Marconi M. VDD single pass lead pacing. Sustained pacemaker mediated tachycardias unrelated to retrograde atrial activation. PACE ) Lamas GA, Pashos CL, McNeil B. Permanent pacemaker selection and subsequent survival in elderly medicare pacemaker recipients. Circulation ) Lau CP, Tai YT, Fong PC, Cheng CH, Chung FLW. Pacemaker mediated tachycardias in single chamber rate responsive pacing. PACE ) Lau CP. Sensor and pacemaker mediate tachycardias. PACE ) Castellanos A, Fernandez PR, Interian Jr A, Myerberg RJ. Pacemaker-induced arrhythmias. In William JM editor. Cardiac Arrhythmias. 3rd ed Philadelphia Lippincott company1995. p ) Stroobandt B, Vandenbulcke F, Falleyn H, Sunnaeve A. Voltage dip in pacemaker battery supply A new cause of pacemaker mediate tachycardia. PACE ) Conti JB, Curtis AB, Hill JA, Raymenants ER. Termination of pacemaker-mediated tachycardia by adenosine. Clin Cardiol ) Lau CP, Tai YT, Fong PC, Lu JPS, Chung FLW. Atrial arrhythmia management with sensor controlled atrial refractory period and automatic mode switching in patients with minute ventilation sensing dual chamber rate adaptive pacemakers. PACE ) Leung SK, Lau CP, Leung WH, Tai YT, Chow FCYH. Apparent extension of the atrioventricular interval due to sensor-based algorithm against supraventricular tachyarrhythmias. PACE ) Ausubel K, Gabry MD, Klementowicz PT, Furman S. Pacemaker-mediated endless loop tachycardia at rate below the upper rate limit. Am J Cardiol Korean Circulation J 2000;303:

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