Automatic mode switching of a dual chamber implantable cardioverter-defibrillator induced by a ventricular escape rhythm.

This report describes a form of group beating induced by a St Jude dual chamber ICD which interpreted a ventricular escape rhythm (with retrograde conduction) as premature ventricular complexes (PVC). These pacemaker-defined PVCs activated the atrial pace-PVC algorithm in 2 steps. 1. The postventricular atrial refractory period (PVARP) was terminated upon detecting a retrograde P wave within its unblanked portion, and 2. An atrial stimulus was released 330ms after the end of the PVARP. This response resulted in automatic mode switching because the 330ms interatrial interval was shorter than the atrial tachycardia detection interval. The arrhythmia may be considered to represent an unusual form of pacemaker escape-capture bigeminy.