PO-04-057 ATRIAL FIBRILLATION CURED BY PACEMAKER REPROGRAMMING

Atrial fibrillation (AF) is commonly detected by remote monitoring of implanted devices. A common question whether to start anticoagulation in patients with AF at risk stroke. However, the cause rarely able be diagnosed or corrected. Repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) a pacemaker mediated arrhythmia that can occur intact (VA) conduction. Ventricular pacing retrograde atrial activation falls within PVARP followed pacing, often delivered while atrium refractory. Retrograde from next ventricular paced beat facilitates repetitive (but non-reentrant) process. arrhythmias may occasionally result. To highlight importance recognizing and correcting RNRVAS as device-mediated arrhythmia. NA 68-year-old man hypertension sinus node dysfunction underwent dual chamber implant (Abbott Assurity). Device interrogation 5-years later showed episodes might warrant anticoagulation. tracings revealed RNRVAS: falling PVARP, competitive sensor driven non-capture, until captured event initiated (Figure, red arrow). Anticoagulation was deferred favor device reprogramming, including: 1) reduction lower rate; 2) AV delay; 3) disabling rate-response. The patient had no further episodes. largely benign but facilitate initiation other supraventricular lead symptoms inappropriate therapy. Both device-triggered underrecognized. Current devices do not have automatic diagnostic treatment algorithms. Therefore, it important aware triggered dual-chamber newly AF. tends long programmed delay (such used avoid pacing) relatively fast rate. Reprogramming shorten delay, decrease rate are primary methods correction. Awareness help therapies.