Ventriculoatrial conduction can cause atrial malpacing in AV universal pacemakers due to retrograde atrial activation.
May prompt evaluation for retrograde VA conduction in unexplained atrial malpacing with dual-chamber pacemakers; case reports leave open prevalence and management implications.
Retrograde atrial activation during ventricular pacing has often been a cause of intermittent or persistent arrhythmias (pacemaker-mediated tachycardia) in AV universal pacemakers. We recently encountered two cases in which VA conduction was responsible for atrial malpacing in patients with an implanted AV universal pacemaker, one programmed in DDD and one in DVI mode. Atrial malpacing was induced by the atrial refractoriness due to retrograde activation. In the first patient, it was observed when the pacemaker was programmed to a rate of 110 ppm (lower rate) and an AV interval of 200 ms in order to check crosstalk. In the second patient, it was observed after ventricular premature contractions.
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GELDER et al. (1985) studied this question.
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