An Unusual Cause of Automatic Mode Switching in the Absence of an Atrial Tachyarrhythmia

2013 ◽  
Vol 37 (6) ◽  
pp. 777-780 ◽  
Author(s):  
MOHAMMED ALMEHAIRI ◽  
ADRIAN BARANCHUK ◽  
AMER JOHRI ◽  
JANE CALDWELL
Keyword(s):  
Mode Switching ◽  
Atrial Tachyarrhythmia ◽  
Automatic Mode ◽  
Automatic Mode Switching

Effect of Varying Atrial Sensitivity, AV Interval, and Detection Algorithm on Automatic Mode Switching

1996 ◽  
Vol 19 (11) ◽  
pp. 1734-1739 ◽  
Author(s):  
EUGEN C. PALMA ◽  
VAIDYA KEDARNATH ◽  
VIREN VANKAWALLA ◽  
CAROLYN A. ANDREWS ◽  
SANDRA HANSON ◽  
...  
Keyword(s):  
Detection Algorithm ◽  
Mode Switching ◽  
Automatic Mode ◽  
Automatic Mode Switching

scholarly journals Dual Atrial Rhythms: A Case Report Of An Unusual Cause Of Pacemaker Syndrome

2022 ◽  
Author(s):  
Natee Sirinvaravong ◽  
Mark Heimann ◽  
Steve Liskov ◽  
Gan-Xin Yan
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
High Rate ◽  
Mode Switching ◽  
Dual Chamber ◽  
P Waves ◽  
Dual Chamber Pacemaker ◽  
Automatic Mode ◽  
Automatic Mode Switching ◽  
Pacemaker Syndrome

Abstract Background Atrial dissociation (AD) is described as the existence of two simultaneous electrically isolated atrial rhythms. Theoretically, detection of dual atrial rhythms with a sufficiently high rate by pacemaker can lead to automatic mode switching and associated pacemaker syndrome. Such a clinical observation has not been reported before in the literature. Case Summary An 87-year-old female with Ebstein’s anomaly status post tricuspid valve annuloplasty and tricuspid valve replacement and a dual chamber pacemaker presented with congestive heart failure one week after undergoing atrial lead revision. Interrogation of her dual chamber pacemaker revealed two atrial rhythms: sinus or atrial-paced rhythm and electrically isolated atrial tachycardia (AT). Sensing of both atrial rhythms by the pacemaker led to automatic mode switching, which manifested as ventricular paced rhythm with retrograde P waves on electrocardiogram (ECG). Adjusting the atrial lead sensitivity to a level higher than the sensing amplitude of AT restored atrial paced and ventricular sensed rhythm, which resulted in resolution of heart failure symptoms. Discussion Regardless of the cause of AD, there must be electrical insulation between the two rhythms for their independent coexistence in the atria. AD can lead to pacemaker syndrome from automatic mode switching. If the sensing amplitude during sinus rhythm is significantly larger than that of AT, adjusting the atrial lead sensitivity would solve the issue, as in the present case. Otherwise, atrial lead revision, pharmacotherapy or AT ablation should be considered.

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