Pacemaker-mediated tachycardia as a pacing maneuver for arrhythmia diagnostics

Key teaching points: Pacemaker-mediated tachycardia induced during ongoing tachyarrhythmias can be useful as diagnostic pacing maneuver in the differential diagnosis of arrhythmias. In Biotronik CRT devices, left ventricular (LV) sensing with an activated T-wave protection algorithm helps to detect and understand desynchronization episodes, but it may also cause unintended loss of LV pacing. Unintended loss of LV-pacing can be addressed by shortening the left ventricular upper rate interval to a minimum of 375ms or by disabling LV-sensing.