Accuracy Of The Pacemaker-mediated Tachycardia Algorithm In Boston Scientific Devices

Authors: M.Strik, A.Frontera, R.Eschalier, P.Defaye, P.Mondoly, P.Ritter, M.Haïssaguerre, S.Ploux, P.Bordachar

Abstract:

Introduction

The incidence of pacemaker-mediated tachycardia (PMT) varies as a function of patient characteristics, device programming and algorithm specificities. We investigated the efficacy of the Boston Scientific algorithm by reviewing PMT episodes in a large device population.

Methods

In this multicenter study, we included 328 patients implanted with a Boston Scientific device: 157 non-dependent patients with RYTHMIQ™ activated (RYTHMIQ group), 76 patients with permanent AV-conduction disorder (AV-block group) and 95 Cardiac Resynchronization Therapy patients (CRT group). For each patient, we reviewed the last 10 remote monitoring-transmitted EGMs diagnosed as PMT.

Results

We analyzed 784 PMT episodes across 118 patients. In the RYTHMIQ group, the diagnosis of PMT was correct in most episodes (80%) of which 69% was directly related to the prolongation of the AV-delay associated with the RYTHMIQ algorithm. The usual triggers for PMT were also observed (PVC 16%, PAC 9%). The remainder of the episodes (20%) in RYTHMIQ patients and most episodes of AV-block (66%) and CRT patients (74%) were incorrectly diagnosed as PMT during sinus tachycardia at the maximal tracking rate. The inappropriate intervention of the algorithm during exercise causes non-conducted P-waves, loss of CRT (sustained in six patients) and may have been pro-arrhythmogenic in one patient (induction of ventricular tachycardia).

Keywords

Clinical: implantable devices – pacemaker-bradyarrhythmias; Clinical: implantable devices – biventricular pacing/defibrillation; Clinical: implantable devices – ventricular tachycardia/fibrillation; Clinical: implantable devices – physiologic pacing; Clinical: cardiac mapping – electrogram analysis

Citation: M.Strik, A.Frontera, R.Eschalier, P.Defaye, P.Mondoly, P.Ritter, M.Haïssaguerre, S.Ploux, P.Bordachar Accuracy Of The Pacemaker-mediated Tachycardia Algorithm In Boston Scientific Devices doi:10.1016/j.jelectrocard.2016.04.004

Available online: 22 April 2016

Copyright: © 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Conclusion

Algorithms to minimize ventricular pacing can occasionally have unintended consequences such as PMT. The PMT algorithm in Boston Scientific devices is associated with a high rate of incorrect PMT diagnosis during exercise resulting in inappropriate therapy with non-conducted P-waves, loss of CRT and limited risk of pro-arrhythmic events.

Acknowledgments

None.

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