Elsevier

Journal of Electrocardiology

Volume 49, Issue 4, July–August 2016, Pages 522-529
Journal of Electrocardiology

Accuracy of the pacemaker-mediated tachycardia algorithm in Boston Scientific devices

https://doi.org/10.1016/j.jelectrocard.2016.04.004Get rights and content
Under a Creative Commons license
open access

Highlights

  • The anti pacemaker-mediated tachycardia algorithm of Boston Scientific devices is explored.

  • Prolongation of AV interval is associated with pacemaker-mediated tachycardia.

  • Sinus tachycardia is a common trigger of false diagnosis of pacemaker-mediated tachycardia

  • Inappropriate pacemaker-mediated tachycardia therapy can have deleterious effects.

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).

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.

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

Cited by (0)

Funding: This work was supported by the French Government, Agence Nationale de la Recherche au titre du programme Investissements d'Avenir [ANR-10-IAHU-04] and by the Dutch Heart Foundation and the Netherlands Heart Institute [to MS].