Published Online
on June 30, 2003

A more recent version of this article appeared on July 15, 2003

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Submitted on December 13, 2002
Revised on April 1, 2003
Accepted on April 9, 2003

Proarrhythmic Effect of Pacemaker Stimulation in Patients With Implanted Cardioverter-Defibrillators

Ewald Himmrich MD^*, Oliver Przibille MD, Christian Zellerhoff MD, Andreas Liebrich MD, Stefan Rosocha MD, Klaus Andreas MD, Dirk Nebeling RN, Babatunde Omogbehin MD, and Jürgen Meyer MD

From II Medical Clinic, University Hospital, Mainz, Germany.

^* To whom correspondence should be addressed. E-mail: himmrich{at}2-med.klinik.uni-mainz.de.

Background--We sought to determine the potential of right ventricular VVI backup pacing to induce ventricular tachyarrhythmias in patients with implanted cardioverter-defibrillators.

Methods and Results--All consecutive patients presenting exclusively with pacemaker-induced tachycardias (PITs) were included in a prospective study using a crossover protocol. Patients were randomized to either group 1 (augmentation of the baseline frequency of the pacemaker to 60 bpm) or group 2 (pacemaker turned off) and were followed up for 1 year and then crossed over to the other programming, looking for reoccurrence of PIT. Of 150 consecutive patients, 39 (26%) had PIT, 13 of them exclusively (8.6%). Forty of 1063 analyzed tachyarrhythmias of all the patients were PIT (3%). Before inclusion in the study, the patients had 2.7±0.9 PITs in 11±6.5 months with their pacemakers programmed empirically at 42.3 bpm. During the study phase, no PIT occurred while the pacemaker was turned off, whereas programming to 60 bpm led to the recurrence of PIT in 5 of 6 patients (1.4±0.6 per patient). At the end of the study, 9 patients underwent a prolonged follow-up with their pacemakers turned off, resulting in spontaneous episodes of ventricular tachycardia/fibrillation in 5 patients, but PITs were no longer observed.

Conclusions--This crossover protocol proves the potential proarrhythmic effect of pacemaker stimulation in implantable cardioverter-defibrillator patients. Resulting PITs led to clinical symptoms and antitachycardia therapy by the implantable cardioverter-defibrillator. Thus, in patients presenting with PIT but without a pacemaker indication, the pacemaker feature should be turned off, or, alternatively, the longest possible escape interval should be programmed.

Key words: electrical stimulation • tachyarrhythmias • pacing • cardioverter-defibrillator

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