Another case report.

Case presentation:

75 y/o woman with non-ichemic dilated cardiomyopathy. Ef 30%.

Implanted with a CRT device (Quadra Assura, St Jude Medical).

ECG

Questions:

  1. What's your diagnosis?
  2. What triggered the tachycardia?
  3. What type of tachycardia is this?
  4. What did the device do and how the tachycardia terminated?

Further Discussion and Final Comments

Comments by Oswaldo Gutierrez

1. PMT algorithm

2. A PVC ocurring during the PAV interval, very lately detected, that elicit a complete recovery of AV node refractoriness

3. PMT

4. The device starts its PMT algorithm: after the 8th measured V-A beat, (basal SAV interval=130 ms), SAV is prolonged 50 ms, in this case, 180 ms: if the A-A interval is prolonged by the same interval, PMT is diagnosed (and atrial tachycardia is eliminated). Then, the next (9th)"AS" event its not tracked and the pacemaker stimulates the atrium at 330 ms (the last AP beat of the tracing) in order to terminate PMT.

 

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