A case of repetitive nonreentrant ventriculoatrial synchrony exacerbating heart failure in dilated cardiomyopathy

Abstract

A 67-year-old man with poor left ventricular function due to a dilated cardiomyopathy was implanted with an implantable cardioverter defibrillator for secondary prevention. Eight years later, he was admitted to our hospital with worsening of heart failure. An electrocardiogram showed a repetitive nonreentrant ventriculoatrial synchrony (RNRVAS). RNRVAS is a device-related arrhythmia that can occur when a dual-chamber pacemaker does not sense a retrograde P wave within the postventricular atrial refractory period, resulting in a repetitive ventricular pacing and noncaptured atrial pacing after the retrograde P wave. We suspected that ventricular pacing caused his heart failure and used the noncompetitive atrial pacing algorithm, which was programmed to prevent RNRVAS. The algorithm was able to prevent the arrhythmia, and the patient successfully recovered from heart failure.

Keywords

• Dual-chamber pacemaker
• Pacemaker arrhythmia
• Ventriculoatrial synchrony
• Postventricular atrial refractory period
• Noncompetitive atrial pacing