Work

When Sleep Mode Becomes a Nightmare

Year: 2025

Type: article

Abstract: BACKGROUND: Atrioventricular node (AVN) ablation preceded by pacemaker insertion is a safe procedure used for both rate and symptom control in symptomatic atrial fibrillation. CASE SUMMARY: This is a case of bradycardia-induced PMVT which occurred after AVN ablation, despite the presence of a VVI-R pacemaker inserted a few months prior. Lower pacing rates were allowed during the night due to 'sleep mode' being enabled. The nocturnal bradycardia resulted in ventricular escape rhythm with frequent ectopy, leading to 'R on T' mediated PMVT. Turning the sleep function off suppressed the ectopic activity and prevented further PMVT. DISCUSSION: PMVT following AVN ablation has been well described in literature. Be it after AVN ablation, or when changing pacemaker programming, the common denominator is a relative bradycardic state which promotes ventricular ectopy and "R on T".

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103638

Authors: Mihai Firescu, Sahar Mohmed, Andrew Thornley, Matthew Dewhurst

Institutions: James Cook University Hospital, University Hospital of North Tees

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850