Abstract
An 89-year-old man with an intermittent 2:1 second-degree atrioventricular block received
a permanent pacemaker (Medtronic Azure XT DR; Medtronic Inc., Minneapolis, MN, USA).
Reactive antitachycardia pacing (ATP) was engaged in all transmissions 3 weeks later.
Intracardiac recordings revealed a far-field R wave (FFRW) oversensing, occurring
between atrial waves and premature atrial contractions. This event triggered the delivery
of reactive ATP, which induced atrial fibrillation. A 79-year-old man underwent permanent
pacemaker implantation for an intermittent complete atrioventricular block. One month
after implantation, reactive ATP was initiated. The atrial electrogram of intracardiac
recordings revealed one being a spontaneous P wave and the other an oversensed R wave.
The criterion for an atrial tachycardia was fulfilled, and the device initiated reactive
ATP. As a result, atrial fibrillation was induced by inappropriate reactive ATP. It
was difficult to completely avoid inappropriate reactive ATP. Finally, we discontinued
reactive ATP. The two cases presented in this study demonstrate the possibility of
inappropriate reactive ATP due to FFRW oversensing, with the inappropriate reactive
ATP inducing atrial fibrillation. All patients treated with reactive ATP should be
carefully assessed for the presence of FFRW oversensing during pacemaker implantation
and during the follow-up period.
Learning objective
We present two cases of inappropriate reactive ATP caused by far-field R-wave oversensing.
Inappropriate reactive ATP has not been previously reported. Therefore, we suggest
that all patients provided with a DDD pacemaker should be carefully assessed for the
presence of FFRW oversensing during pacemaker implantation and during the follow-up
period. Remote monitoring enables very early detection of inappropriate reactive ATP
delivery for rapid implementation of preventive measures.
Keywords
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Article info
Publication history
Published online: March 06, 2023
Accepted:
February 22,
2023
Received in revised form:
February 18,
2023
Received:
December 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
