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Rate-dependent pacing failure after pacemaker implantation: Novel insights into the mechanism of using adenosine.

Hisaharu OheYasushi OginosawaYasunobu YamagishiTaro MiyamotoTsukahara KeitaRitsuko KohnoHaruhiko AbeYutaka Otsuji
Published in: Journal of cardiovascular electrophysiology (2020)
An 82-year-old woman received pacemaker implantation for sick sinus syndrome. Two days after the implantation, electrocardiography showed 2:1 atrial pacing failure, followed by a bradycardia-dependent increase in the atrial pacing threshold during a pacemaker examination. However, transient 1:1 atrial pacing capture recovered by adenosine triphosphate (ATP) administration, which was performed to evaluate the bradycardia-dependent pacing failure mechanism. We considered this phenomenon to be caused by Phase 4 depolarization and avoided replacing this atrial lead. Three weeks later, the atrial pacing threshold had improved. We report the potential role of Phase 4 depolarization in a bradycardia-dependent increase in pacing threshold by using ATP.
Keyphrases
  • cardiac resynchronization therapy
  • atrial fibrillation
  • left atrial
  • left ventricular
  • heart failure
  • case report
  • vena cava
  • brain injury
  • risk assessment
  • protein kinase
  • human health