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  • Title: Paradoxical atrial undersensing: noise rate reversion or amplifier ringing?
    Author: Van Gelder BM, Van Den Broek W, Bracke FA, Meijer A.
    Journal: J Cardiovasc Electrophysiol; 2006 Dec; 17(12):1371-4. PubMed ID: 16978248.
    Abstract:
    Atrial tachy-arrhythmias may give rise to mode switching or noise rate reversion in dual-chamber pacemakers. In case of high amplitude of the atrial electrogram during tachycardia, a paradoxical behavior of atrial sensitivity programming can be observed. Two patients with implanted dual-chamber pacemakers showed intermittent and complete loss of atrial sensing during atrial tachycardia during device programming to a higher atrial sensitivity setting. This phenomenon is caused by amplifier ringing and can be considered as a state of amplifier saturation, which disables atrial sensing in spite of the high amplitude of the atrial signal. In patients with high amplitude of the atrial electrogram during atrial tachycardia, a paradoxical behavior of sensitivity programming resulting in atrial undersensing can be observed.
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