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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Failure of automatic mode switching: recognition and management.
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Failure of automatic mode switching: recognition and management.

机译：自动模式切换失败：识别和管理。

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摘要

Dual chamber pacing is desirable to optimize AV synchrony and to potentially decrease the incidence of supraventricular tachyarrhythmias. Patients with alternating periods of both supraventricular tachyarrhythmias and bradycardia pose a difficult challenge when standard dual chamber pacemakers are implanted. The automatic mode switching mode algorithm was introduced to prevent tracking of paroxysmal supraventricular tachyarrhythmias and avoid the adverse hemodynamic and symptomatic consequences of a rapid ventricular response. In some cases, failure to mode switch may take place when the atrial signal during tachycardia is of insufficient amplitude to be sensed. Failure to mode switch may also occur when the atrial signal periodically occurs in the atrial blanking period(s). In this article, we describe failure to mode switch in seven patients with paroxysmal supraventricular tachyarrhythmias after a Telectronics Meta DDDR 1254 device was implanted. Each patient had paroxysmal atrial flutter and/or atrial fibrillation and presented with either repetitive episodes of oscillation between atrial tracking and mode switching to a nonatrial tracking pacing mode or complete failure to mode switch. Six of seven patients were taking antiarrhythmic drugs that resulted in slowing of the atrial cycle length. Pacemaker reprogramming was required in each case to restore reliable mode switching during subsequent recurrences of the atrial tachyarrhythmias. We conclude that careful pacemaker programming of patients with paroxysmal atrial flutter and the Telectronics Meta DDDR 1254 is necessary when patients are taking an antiarrhythmic drug that slows atrial cycle length.
机译：需要双腔起搏以优化房室同步性并潜在地减少室上性快速性心律失常的发生率。当植入标准的双室起搏器时，室上性快速性心律失常和心动过缓交替出现的患者面临着艰巨的挑战。引入了自动模式切换模式算法，以防止跟踪阵发性室上性快速性心律失常，并避免快速心室反应的不良血流动力学和症状后果。在某些情况下，当心动过速期间的心房信号幅度不足以感知时，可能会发生模式切换失败。当心房信号在心房消隐期中周期性发生时，也可能发生模式切换失败。在本文中，我们描述了在植入Telectronics Meta DDDR 1254设备后发生阵发性室上性快速性心律失常的7例患者模式切换失败的情况。每个患者都有阵发性心房扑动和/或房颤，并且表现为在心房追踪和模式切换至非心房追踪起搏模式之间反复发作或完全无法切换模式。七名患者中有六名正在服用抗心律失常药物，导致心房周期长度减慢。在每种情况下都需要起搏器重新编程，以在心房快速性心律失常的后续复发中恢复可靠的模式切换。我们得出结论，当患者服用减慢心律周期的抗心律不齐药物时，对阵发性心房扑动和Telectronics Meta DDDR 1254患者进行仔细的起搏器编程是必要的。

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