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Europace Advance Access published online on May 25, 2007
Europace, doi:10.1093/europace/eum079
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

CASE REPORT

Tachycardia after pacemaker implantation in a patient with complete atrioventricular block

Gabor Z. Duray, Carsten W. Israel, Florian T. Wegener and Stefan H. Hohnloser*

Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Theodor Stern Kai 7, 60590 Frankfurt, Germany

The atrioventricular (AV) node allows ante- and retrograde conduction between atria and ventricles. It is commonly assumed that these AV nodal conduction properties go hand in hand. However, ante- and retrograde AV conduction can be completely independent from each other in individual patients. We report about a patient with permanent AV block III° requiring implantation of a pacemaker. As soon as a dual-chamber device was connected to the implanted leads, a tachycardia started at the maximum tracking rate, which was subsequently reprogrammed from 120 to 170 bpm. Non-invasive electrophysiologic testing showed that this patient demonstrated 1:1 ventriculoatrial (VA) conduction up to 170 bpm leading to endless loop tachycardia (ELT) while the antegrade AV block III° persisted. This case impressively illustrates that one has to take into account that patients with antegrade AV block III° may still have a high VA conduction capacity leading to ELT. Dual-chamber devices therefore have to be programmed accordingly, activating dedicated reactions after ventricular premature beats and automatic ELT detection and termination algorithms.

Key Words: AV block, Retrograde conduction, Endless loop tachycardia, Pacemaker mediated tachycardia, Pacemaker circus movement tachycardia, Dual-chamber pacing

* Corresponding author. Tel: +49 69 6301 7404; fax: +49 69 6301 7017. E-mail address: hohnloser{at}em.uni-frankfurt.de

Manuscript submitted 10 November 2006. Accepted after revision 30 March 2007.


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