Can you experience tachycardia (fast heart rate) with a pacemaker (artificial cardiac pacemaker)?

Can You Have a Fast Heart Rate with a Pacemaker?

Yes, you can experience tachycardia (fast heart rate) with a pacemaker through several mechanisms, including pacemaker-mediated tachycardia, underlying arrhythmias, or intentional programming of the pacemaker for specific clinical conditions. 1

Mechanisms of Tachycardia with Pacemakers

• Pacemaker-Mediated Tachycardia (PMT): This occurs when a reentrant circuit forms between the atrium and ventricle in dual-chamber pacemakers, creating a sustained rapid heart rate 2

• Runaway Pacemaker: A rare but serious malfunction where battery depletion or component failure causes the pacemaker to pace at dangerously high rates, potentially leading to ventricular tachycardia or fibrillation 3

• Underlying Arrhythmias: Pacemakers don't always prevent native tachyarrhythmias, particularly atrial fibrillation or atrial flutter, which can still occur despite pacemaker presence 1

• Programmed Fast Rates: Some pacemakers are intentionally programmed to pace at higher rates for specific therapeutic purposes 4

Pacemaker Types and Their Relationship to Tachycardia

Rate-Responsive Pacemakers (VVIR, DDIR, DDDR)

• These pacemakers can increase heart rate in response to physical activity or other physiological needs 1
• They are particularly useful in patients with chronotropic incompetence (inability to appropriately increase heart rate with exertion) 1
• VVIR pacemakers are contraindicated when angina or heart failure is worsened by fast rates 1

DDD Pacemakers

• These can track rapid atrial rates and conduct them to the ventricles, potentially causing tachycardia 1
• In patients with paroxysmal atrial tachyarrhythmias, this can lead to rapid ventricular pacing 1

Therapeutic Uses of Pacemaker-Induced Tachycardia

• Antitachycardia Pacing: Some pacemakers are specifically designed to detect and terminate tachyarrhythmias by delivering rapid pacing sequences 1, 5

• Therapeutic Heart Rate Elevation: Research has explored using nocturnal heart rate elevation (to approximately 100 beats/min) as a potential treatment for diastolic dysfunction 4

• Bradycardia-Tachycardia Syndrome: Pacemakers may be indicated in patients who require antiarrhythmic medications that can cause bradycardia 1

Management of Pacemaker-Related Tachycardia

• PMT Management: Can be diagnosed and treated through pacemaker interrogation and reprogramming 2

• Prevention Strategies:

  • Programming appropriate upper rate limits 1
  • Setting post-ventricular atrial refractory periods (PVARP) to prevent PMT 1
  • Using mode-switching algorithms to prevent tracking of atrial tachyarrhythmias 1

• Regular Follow-up: Essential to detect early signs of pacemaker malfunction that could lead to inappropriate tachycardia 3

Clinical Pitfalls and Considerations

• Magnet application can temporarily resolve PMT by switching the pacemaker to asynchronous mode, which can be diagnostic 2

• Patients with accessory pathways capable of rapid antegrade conduction should not receive certain types of pacemakers due to risk of dangerous tachyarrhythmias 1

• Pacemaker-induced tachycardia can be mistaken for other forms of tachycardia, leading to inappropriate treatment 2

• Battery depletion may present with increasing paced heart rates before complete failure, requiring prompt generator replacement 3