Pacemaker-Mediated Tachycardia - Causes, Symptoms, Diagnosis, Treatment, and Complications

Creator: Dr. Shaqra Ekram
Published: 2022-12-21T14:44:59

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Pacemaker-mediated tachycardia is an arrhythmia with dual-chamber pacemakers due to reentry. This article is an overview of pacemaker-mediated tachycardia.

Written by

Dr. Shaqra Ekram

Medically reviewed by

Dr. Prashant Valecha

December 21, 2022

May 6, 2024

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Contents

What Are the Causes of Pacemaker Mediated Tachycardia?
What Are the Signs and Symptoms of Pacemaker-Mediated Tachycardia?
How to Diagnose Pacemaker-Mediated Tachycardia?
How to Treat Pacemaker-Mediated Tachycardia?
What Are the Complications of Pacemaker-Mediated Tachycardia?

Introduction

The pacemaker was invented in 1958, and since then, doctors have reported a drastic decrease in diseases related to cardiac output. A pacemaker is a device that is placed inside the body to aid in controlling the heart. It is possible to put more than one pacemaker in the heart. It is set for a temporary time frame, as suggested by the healthcare provider. A pacemaker is implanted under the skin of the chest. Pacemaker implantation is not a very invasive surgery and does not require opening the heart.

The principal function of the pacemaker is to send electrical signals to the heart to stabilize the heart rate and bring down the contraction of the heart's lower chambers to standard limits. Pacemakers have established themselves as a long-term treatment modality for life-threatening arrhythmias and can also improve the patient's quality of life. The heart is divided into four chambers.

The above two chambers are the left and right atrium, and the lower two are called the left and right ventricles. In the case of two pacemakers, one is placed in the atrium of the heart, and the other is placed in the ventricles. Thus the presence of two pacemakers may result in tachycardia. The simple meaning of tachycardia is an abnormally rapid heartbeat.

What Are the Causes of Pacemaker Mediated Tachycardia?

There are several reasons for the heart rhythm to turn abnormal. Pacemaker-mediated tachycardia, or PMT, is usually any abnormal heart rhythm that occurs solely due to a pacing device such as a pacemaker. Nevertheless, it should be noted that a classic case of pacemaker-mediated tachycardia generally occurs because of a reentrant in dual-chambered pacemakers.

Below are some of the causes of pacemaker-mediated tachycardia.

Patients with sick sinus syndrome.
Patient with atrioventricular block.
Presence of two pacemakers, one in the atrium and the other in the ventricles.
An event that detaches the P wave from the QRS complex is read in an electrocardiograph.
Premature ventricular contraction.
Premature atrial contraction.
Loss of atrial sensing of atrial capture.
Retrograde atrioventricular conduction.
Elongated ventriculoatrial conduction.
An outdated pacemaker.
Malfunctioning of one or both pacemakers.

What Are the Signs and Symptoms of Pacemaker-Mediated Tachycardia?

Pacemaker-mediated tachycardia is a type of abnormal heart rhythm that occurs in patients who have pacemakers in two chambers of the heart. Patients who suffer from pacemaker-mediated tachycardia have a range of clinical manifestations. All of them are with respect to the consequences of the increased heartbeat. There are many hemodynamic changes in the body as well that may result in some of the below-mentioned signs and symptoms of pacemaker-mediated tachycardia. It should be kept in mind that there are records of patients suffering from pacemaker-mediated tachycardia but not showing any signs or symptoms.

Chest pain or chest discomfort.
Dizziness.
Syncope.
Palpitations.
Cardiac arrest.
Shortness of breath.
Weakness.
Irregular heartbeat.
Swelling in the abdomen.
Swelling in the ankles, feet, and legs.
Fatigue.
Persistent cough.
Reduced ability to perform daily activities.
Hypotension.

How to Diagnose Pacemaker-Mediated Tachycardia?

Underlying medical history, especially cardiovascular history, is very important. Additionally, the entire information of the pacemaker must be known, such as the device model, date of manufacture, etc. it should also be kept in mind that an asymptomatic patient with pacemakers does not rule out the possibility of diagnosing pacemaker-mediated tachycardia. The majority of the patients who have two pacemakers in their hearts should be assessed for pacemaker tachycardia. Electrocardiogram reveals any alteration in the rhythm of the heart. A firm diagnosis of pacemaker-mediated tachycardia is carried through the below-mentioned diagnostic procedures.

Electrocardiograph.
Telemeter intracardiac electrograms.
Treadmill test.
Unipolar electrogram.
Atrial pacing markers.

How to Treat Pacemaker-Mediated Tachycardia?

A drastic end to pacemaker-mediated tachycardia can be sought by putting into action the magnetic forces in the pockets of the pacemaker. This result is possible because the pacemaker usually is programmed to make a riposte to any magnetic interference. Asynchronous pacing mode can be reached by switching to this magnetic application. In simple terms, the pacemaker will be set to not work according to the atrial activity but instead to only work at the rate that has been established. This will, in turn, end the circuit and put a stop to persistent tachycardia.

Below mentioned are the other ways to treat pacemaker-mediated tachycardia.

Temporary massage of the carotid artery.
Medication that blocks the atrioventricular nodes.
Administration of Digoxin.
Drugs such as beta-blockers.
Calcium channel blockers.
Non-dihydropyridine blockers.
Drugs to secure the retrograde limb in the circuit
Altering the sensitivity of the atrial lead.

The most conclusive line of treatment for pacemaker-mediated tachycardia is to reset or reprogram the pacemaker. This will cancel the option of recurrence of pacemaker-mediated

tachycardia. The healthcare provider, along with the team of interprofessional, will correct the pacemaker. In the long term, changing the pacemaker may be advised by the healthcare professional to restore the contracting balance between the atrium and ventricles.

What Are the Complications of Pacemaker-Mediated Tachycardia?

Some of the expected difficulties can be an episode of syncope or dizziness. These episodes may lead to the patient losing balance and hurting themselves in other body parts such as the head, joints, etc. There are currently no records or documentation of complications due to pacemaker-mediated tachycardia.

Conclusion

Pacemaker-mediated tachycardia is a condition where patients who have two pacemakers in their hearts suffer from altered heart rhythms. This generally happens when there is a pacemaker in the atrium and another pacemaker in the ventricle. Patients suffer from symptoms that are similar to that of heart failure. Patients should immediately report to their healthcare provider in case they feel an abnormality in their heart rate or increased episodes of palpitations. This condition is easily treated, and the long-term prognosis is good. Patient education is essential regarding their pacemaker device, which may seldom be a source of irregular heart rhythms.

Frequently Asked Questions

1. Can Pacemakers Correct Tachycardia?

Yes, a drastic end to pacemaker-mediated tachycardia can be sought after by putting into action the magnetic forces in the pockets of the pacemaker. This result is possible because the pacemaker usually is programmed to make a riposte to any magnetic interference. Asynchronous pacing mode can be reached by switching to this magnetic application.

2. How to Treat Pacemaker-Mediated Tachycardia?

- Temporary massage of the carotid artery.
- Medication that blocks the atrioventricular nodes.
- Administration of Digoxin.
- Drugs such as beta-blockers.
- Calcium channel blockers.
- Non-dihydropyridine blockers.
- Drugs to secure the retrograde limb in the circuit
- Altering the sensitivity of the atrial lead.

3. Can a Pacemaker Lead To Ventricular Tachycardia?

A pacemaker surgery has been shown to result in ventricular tachycardia during the first two days of implantation. The main reason for this is the electrolyte imbalance after the surgical procedure. Hypoxia may also add to the cause. It should be noted that both the causes are easily reversible.

4. What Are the Causes of Pacemaker-Mediated Tachycardia?

- Patients with sick sinus syndrome.
- Patient with atrioventricular block.
- Presence of two pacemakers, one in the atrium and the other in the ventricles.
- An event that detaches the P wave from the QRS complex; is read in an electrocardiograph.
- Premature ventricular contraction.
- Premature atrial contraction.
- Loss of atrial sensing of atrial capture.
- Retrograde atrioventricular conduction.
- Elongated ventriculoatrial conduction.
- An outdated pacemaker.
- Malfunctioning of one or both pacemakers.

5. What Is the Normal Heart Rate With a Pacemaker?

After the implantation and regular functioning of a pacemaker, the normal heart rate of the patient is expected to be around 60 beats per minute, which may go up to 75 beats per minute.

6. What Can Be Done to Fix Pacemaker-Mediated Tachycardia?

Some of the ways to manage pacemaker-mediated tachycardia are:
- Magnet application.
- Carotid massage.
- Medications: Digoxin, beta-blockers, and non-dihydropyridine calcium channel blockers.
- Reprogramming the pacemaker.

7. Can a Pacemaker Control Tachycardia?

A pacemaker or implantable cardioverter-defibrillator (ICD) is an implantable divide that can be implemented to manage certain types of tachycardia by providing a pacing therapy. Traditionally, pacemakers are implemented to manage bradycardia, so other treatment modalities may be preferred over pacemakers in treating tachycardia.

8. When Does Pacemaker Tachycardia Become Necessary?

A pacemaker is typically used to treat bradycardia, not tachycardia. However, in certain situations, specialized pacemakers with tachycardia detection and pacing may be used to manage certain tachyarrhythmias conditions like bradycardia-tachycardia syndrome or chronotropic incompetence. In conditions like these, the heart does not appropriately pace when needed.

9. Which Is the Pacemaker Used for Ventricular Tachycardia?

It is typically better to manage ventricular tachycardia with mediations, catheter ablation, cardioversion, or defibrillator. In a select few cases, a special pacemaker-implantable cardioverter-defibrillator (ICD) may be implanted under the skin, which detects ventricular tachycardia or ventricular fibrillation and can deliver a shock to restore normal ventricular rhythm.

10. How Long Is a Heart Pacemaker Viable?

The lifespan of a pacemaker depends on the type of device, its programming and the patient’s lifestyle. However, an estimated lifespan of six to ten years may be expected of modern pacemakers. Some of them even last for up to 15 years, based on the type of device and how often it delivers a shock. The battery life is regularly monitored by the cardiologists, and a simple surgical procedure is needed to replace the device without disturbing the leads.

11. What Is the Lifespan of a Pacemaker Lead?

The lifespan of pacemaker leads depends on the type of lead and age, health, and lifestyle of the patient. Modern leads can last up to 15 to 20 years. The patient usually undergoes regular cardio check-ups to ensure the health of the leads. If any damage or potential aging is detected, it is advised to get the leads replaced for continued functioning.

12. Which Is the Life-Threatening Tachycardia?

All kinds of tachycardia may be life-threatening based on the individual’s underlying conditions and the patient’s overall health. Ventricular tachycardia is a high heart rate for a short amount of time; however, episodes lasting for an extended period can definitely be life-threatening.

13. What Is the Maximum Sustainable Time Limit for the Heart in Tachycardia?

Tachycardia can last for a few seconds, a few minutes, or even hours. Supraventricular tachycardia is not usually fatal, but tachycardia lasting for over 30 minutes can be very life-threatening. It becomes an emergent situation, and the patient needs to be admitted for expert intervention.

14. What Is the Consequence of Untreated Tachycardia?

Tachycardia may not produce any persistent symptoms or complications. However, such episodes are a matter of concern. Unmanaged or poorly managed tachycardia can lead to several heart conditions like heart failure, stroke, or sudden cardiac death.

15. How to Best Treat Tachycardia With Medications?

Some of the pharmacotherapeutic methods of tachycardia management are:
- Antiarrhythmic Drugs: Amiodarone, Flecainide, etc.
- Calcium Channel Blockers: Amlodipine, Diltiazem, etc.
- Beta-blockers: Acebutolol, Atenolol, Bisoprolol, etc.
- Anticoagulants: Dabigatran, Apixaban, etc.

16. How to Rapidly Reduce Tachycardia?

Some of the ways to rapidly manage tachycardia are:
- Vagal maneuvers.
- Medications.
- Cardioversion.
- Magnet (if a pacemaker is implanted).

17. Is It Possible to Cure Tachycardia?

Tachycardia cannot be cured but can be managed with appropriate interventions. Tachycardia is often harmless and subsides on its own. A cardiologist may prescribe several medications, implanted devices, exercise, or surgeries to control tachycardia episodes.

18. Is It Possible for the Pacemaker to Damage the Heart?

It is uncommon to see complications surrounding a pacemaker. Infections near the site of the implant, swelling, bruising, and bleeding at the pacemaker site may be seen. According to a report, activating the pacemaker function on the right-hand side of the patient can throw off the synchronization with the left half, which may cause the heart to deteriorate.

19. When to Stop a Pacemaker?

A pacemaker does not need to be deactivated in end-of-life situations unless the patient or the family requests so. This is done if the device is prolonging the dying process. This brings forth the ethical dilemma. Pacemakers are stopped when it is time to withdraw life support.

20. Is It Possible to Live a Long Normal Life With a Pacemaker?

According to a study, it was proven that individuals might live a long normal life with a pacemaker. The mean age of deceased patients was more than 78 years which is evidence enough to prove the effectiveness of an implantable pacemaker. The median survival time post-implantation was just shy of 102 months (eight years and six months).

Sources

Dr. Prashant Valecha

Cardiology

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