Key result
Setting the maximum tracking rate 20 bpm above the heart rate is hemodynamically superior to setting it 10 bpm above, resulting in a minimum AP-VS interval of 96 ms versus 83 ms.
Why the study?
Does setting the maximum tracking rate 20 bpm above the tachycardia rate improve the AP-VS interval compared to 10 bpm in R-wave synchronised atrial pacing for postoperative junctional ectopic tachycardia?
Does setting the maximum tracking rate 20 bpm above the tachycardia rate improve the AP-VS interval compared to 10 bpm in R-wave synchronised atrial pacing for postoperative junctional ectopic tachycardia?
Setting the maximum tracking rate 20 bpm above the tachycardia rate provides a safer, more hemodynamically appropriate AP-VS interval than a 10 bpm offset during R-wave synchronised atrial pacing for postoperative junctional ectopic tachycardia.
May favor wider MTR offset in postoperative JET pacing; leaves open randomized confirmation.
BACKGROUND: R-wave synchronised atrial pacing is an effective temporary pacing therapy in infants with postoperative junctional ectopic tachycardia. In the technique currently used, adverse short or long intervals between atrial pacing and ventricular sensing (AP-VS) may be observed during routine clinical practice. OBJECTIVES: The aim of the study was to analyse outcomes of R-wave synchronised atrial pacing and the relationship between maximum tracking rates and AP-VS intervals. METHODS: Calculated AP-VS intervals were compared with those predicted by experienced pediatric cardiologist. RESULTS: A maximum tracking rate (MTR) set 10 bpm higher than the heart rate (HR) may result in undesirable short AP-VS intervals (minimum 83 ms). A MTR set 20 bpm above the HR is the hemodynamically better choice (minimum 96 ms). Effects of either setting on the AP-VS interval could not be predicted by experienced observers. In our newly proposed technique the AP-VS interval approaches 95 ms for HR > 210 bpm and 130 ms for HR < 130 bpm. The progression is linear and decreases strictly (- 0.4 ms/bpm) between the two extreme levels. CONCLUSIONS: Adjusting the AP-VS interval in the currently used technique is complex and may imply unfavorable pacemaker settings. A new pacemaker design is advisable to allow direct control of the AP-VS interval.
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Entenmann et al. (2017) studied Postoperative junctional ectopic tachycardia (n=6). Maximum tracking rate set 20 bpm above heart rate (M20) vs. Maximum tracking rate set 10 bpm above heart rate (M10) was evaluated on Minimum AP-VS interval. Setting the maximum tracking rate 20 bpm above the heart rate is hemodynamically superior to setting it 10 bpm above, resulting in a minimum AP-VS interval of 96 ms versus 83 ms.
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