Far-field R wave sensing causing prolongation of the atrial escape interval of DDD pacemakers with atrial-based lower rate timing

This report describes the occurrence of prolonged atrial escape intervals (AEI) initiated by sensing of ventricular premature complexes (VPC) without a preceding atrial depolarization or an AV delay in two patients with DDD pacemakers with an atrial-based lower rate response. The prolonged AEIs were due to ventriculoatrial cross-talk so that atrial sensing of the far-field R wave of the VPCs occurred before detection of the R wave by the ventricular channel as a near-field signal. Early atrial sensing of the far-field R wave was promoted by a high atrial sensitivity and/or low ventricular sensitivity and was eliminated by reducing atrial sensitivity and/or increasing ventricular sensitivity. This manifestation of far-field sensing should not be interpreted as malfunction of dual chamber pacemakers with atrial-based lower rate timing.