Management of Tachyarrhythmias with Dual‐Chamber Pacemakers

VICTOR MEDINA‐RAVELL, AGUSTIN CASTELLANOS, BOLIVAR PORTILLO‐ACOSTA, CASTOR MADURO‐MAYTIN, LUIS RODRIGUEZ‐SALAS, MANUEL HERNANDEZ‐ARENAS, RAUL LA SALLE‐TORO, IVAN MENDOZA‐MUJICA, MANUEL ORTEGA‐MALDONADO, BAROUH V. BERKOVITS

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Abstract

Des stimulaleurs multiprogrammables AV séquentiels de type “double‐demande” (DVI, MN) ont été implantés chez 23 patienls porteurs ?anomalies variées de tachycardies supraventriculaires. De plus, des stimuloteurs AV séquenfiels à paire “nonobligée” (DVI, MN e(DDD, M) ont été utilisés pour le traitement de lachyarhythmies ventriculaires. Nous avons observé que ľexpérience avec ee type de stimulateur multiprogrammable est favorable chez les patients sans fibrillation auriculaire chronique, qui ont besoin ?un stimutafeur et qui nécéssitent un froilement anti‐tachycardique. Ľévolution des stimulateurs du type DDD contribuera sans doute à un traitement encore plus éfficace. Multi‐programmable dual‐demand AV sequential (DVI, MN) pacemakers were implanted in twenty‐three potients (in one of them a DVI, MN unit was used as a VVI, MN with the aid of an atrial plug) with suproventricular tachycardias after electrophysiological studies revealed a great voriety of AV reentry circuits. The latter included tachycardios involving accessory pathways of the Kent type, manifest or concealed Wolff‐Parkinson‐White syndromes, nodo‐ventricular (Mahaim) tracts, “enhanced” AV node for extra AV nodal) pothwaysand dual AV pathways. In addition, multiprogrammable “non‐committed” AV sequential (DVI, MN and DDD, M) pacemakers were permanently implonted to treat different forms of ventricular tachyarrhythmias that included: torsode de pointes in the Romano‐Ward syndrome and Chagas' cardiomyopathy, ventricular tachycordia which is bradycardia‐dependent (in Chagas' cardiomyopathy) and reciprocal beats indueed by, and producing severe hemodynamic derangements in a patient with a conventional VVI unit. With smallsize multiprogrammable units, arrhythmias may be treated by changing parameters non‐invasively. By temporary inhibition, one may analyze the underlying rhythm and pacemaker dependency. In potients without chronic atrial flutterJfibrillation who require pacing and possibly tachyarrhythmia control, our experience with multiprogrammable “non‐committed” AV sequential pacing has been very satisfactory. The evolution toward newer pacing modes which provide atrial sensing and trackmg (DDD), and thus preserve AV synchrony over a wider range of atrial rates, may contribute even further to successful patient management. This may be applicable to pediatric patients as well.

Original languageEnglish (US)
Pages (from-to)333-345
Number of pages13
JournalPacing and Clinical Electrophysiology
Volume6
Issue number2
DOIs
StatePublished - Mar 1983

Keywords

  • dualchamber pacemakers
  • multiprogrammable pacemakers
  • supraventriculor tachycardias
  • ventricular tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    MEDINA‐RAVELL, VICTOR., CASTELLANOS, AGUSTIN., PORTILLO‐ACOSTA, BOLIVAR., MADURO‐MAYTIN, CASTOR., RODRIGUEZ‐SALAS, LUIS., HERNANDEZ‐ARENAS, MANUEL., LA SALLE‐TORO, RAUL., MENDOZA‐MUJICA, IVAN., ORTEGA‐MALDONADO, MANUEL., & BERKOVITS, BAROUH. V. (1983). Management of Tachyarrhythmias with Dual‐Chamber Pacemakers. Pacing and Clinical Electrophysiology, 6(2), 333-345. https://doi.org/10.1111/j.1540-8159.1983.tb04370.x