DDD pacemakers should be used with caution in patients with sick sinus syndrome and associated atrial tachyarrhythmias due to the risk of tracking atrial flutter.
Case reports of atrial flutter tracking causing sustained upper-rate pacing support vigilance with DDD devices in arrhythmia-prone patients; leaves open need for confirmatory studies.
Two patients who had DDD pacemakers inserted for symptomatic sick sinus syndrome developed sustained upper-rate limit pacing. It was demonstrated in these two patients that pacemaker-mediated tachycardia was due to tracking of atrial flutter. DDD pacemakers should be used with caution in patients with the sick sinus syndrome and associated atrial tachyarrhythmias. Medical treatment of recurrent atrial tachyarrhythmias may allow patients to remain in the DDD mode.
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Greenspon et al. (1984) studied this question.
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