Managed ventricular pacing (MVP) should be used with caution in patients at risk for brief heart block (e.g., sleep apnea), as it can permit short-long-short sequences leading to polymorphic ventricular tachycardia.
MVP may trigger polymorphic VT in transient AV block; single case leaves open whether to avoid MVP in patients prone to brief pauses.
We report a case of a patient with an implantable cardioverter defibrillator and no prior history of heart block with managed ventricular pacing (MVP) programmed who had frequent recurrent episodes of polymorphic ventricular tachycardia. All of the episodes were initiated by transient atrioventricular block which resulted in short-long-short sequences permitted by MVP. This case illustrates that MVP should be used with caution not only in patients with complete heart block, but also in patients at risk for brief heart block due to such states as hypervagatonia due to sleep apnea.
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Vavasis et al. (2009) studied this question.
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