Highlights the potential for the ventricular blanking period to participate in the initiation of pacemaker-mediated tachycardias, which can be managed by reprogramming atrial sensitivity.
May prompt atrial sensitivity adjustment in refractory PMT; hypothesis-generating for blanking-period roles in device tachycardias.
Pacemaker-mediated tachycardias (PMT) have received much recent attention. We describe the course and treatment of a 60-year-old man with an AV universal (DDD) pacemaker who developed a pacemaker-mediated tachycardia. The tachycardia was initiated by the coincidence of an unsensed P-wave, a QRS that was also not sensed due to the ventricular blanking period, and a short right ventricular myocardial effective refractory period. Treatment consisted of reprogramming the atrial sensitivity of the device. Physicians should be aware of the potential for the ventricular blanking period to participate in the initiation of pacemaker mediated tachycardias.
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Lamas et al. (1985) studied this question.