Cross-ventricular pacemaker-mediated tachycardia by myopotential induction during biventricular pacing.

Background: Patients in permanent atrial fibrillation treated for heart failure and ventricular asynchrony can be implanted with conventional dual chamber pacemakers (DDD) pacemakers used in the biventricular mode. The left ventricular lead is connected to the atrial channel.

Case Report: We report the case of a patient who developed ventriculo-ventricular pacemaker-mediated tachycardia (PMT) induced by myopotential sensing in the atrial channel, inhibiting left ventricular pacing.

Conclusion: In the absence of specifically designed pacemakers, the use of DDD pacemakers in the biventricular mode requires certain precautions, such as anti-PMT mode activation, disabling automatic sensitivity, and lengthening the postventricular atrial refractory period (PVARP), or mode switch to DVIR.