Apparent P Wave Underselling in a DDD Pacemaker Post Exercise |
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Authors: | BERRY M van GELDER ROB van MECHELEN KAREL den DULK MAMDOUH IH el GAMAL |
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Institution: | Department of Cardiology, Catharina Hospital, Eindhoven;Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam;Department of Cardiology, University of Limburg, Maastricht, The Netherlands |
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Abstract: | Wencke-bach behavior of DDD pacemakers occurring when the P-P interval varies between the programmed upper rate interval and the total atrial refractory period is symmetrical in a sense that the pacemaker response during atrial rate acceleration is similar to the pacemaker response during atrial rate deceleration. This phenomenon can be observed in all patients with persistent AV block in whom a DDD pacemaker is implanted, during exercise testing when the spontaneous atrial rate exceeds the selected upper rate, i.e., the programmed upper rate interval. However, this phenomenon will not be observed in all patients with intermittent intact AV conduction during exercise. In this case report we describe a patient who showed an asymmetrical response during a bicycle exercise test. There was 1:1 atrial sensing ventricular pacing until the atrial rate exceeded the upper rate of 140 ppm, while atrial sensing was restored during recovery when the conducted sinus rhythm had decreased to 105 beats/min. |
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Keywords: | dual chamber pacemaker upper rate behavior exercise apparent P wave under sensing |
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