Case Reports Korean Circulation J 2000;303:334-338 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;303:334-338 KEY WORDPacemaker-mediated tachycardia. 서 론 334
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
Fig. 1. PMT of case 1. 24 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 2. 24 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;303:334-338
Table 2. Pacemaker settings and PMT data pt. AVD ms PVARP ms VACT ms URL PMT CL ms Rate bpm CL ms Rate bpm 1 225 200 220 428 140 440 136 2 225 175 280 461 130 500 120 3 120 270 340 400 150 460 130 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
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