Accuracy of the pacemaker-mediated tachycardia algorithm in Boston Scientific devices

M. Strik*, A. Frontera, R. Eschalier, P. Defaye, P. Mondoly, P. Ritter, M. Haissaguerre, S. Ploux, P. Bordachar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: The incidence of pacemaker-mediated tachycardia (PMT) varies as a function of patient characteristics, device programming and algorithm specificities. We investigated the efficacy of the Boston Scientific algorithm by reviewing PMT episodes in a large device population. Methods: In this multicenter study, we included 328 patients implanted with a Boston Scientific device: 157 non-dependent patients with RYTHMIQ (TM) activated (RYTHMIQ group), 76 patients with permanent AV-conduction disorder (AV-block group) and 95 Cardiac Resynchronization Therapy patients (CRT group). For each patient, we reviewed the last 10 remote monitoring transmitted EGMs diagnosed as PMT. Results: We analyzed 784 PMT episodes across 118 patients. In the RYTHMIQ group, the diagnosis of PMT was correct in most episodes (80%) of which 69% was directly related to the prolongation of the AV-delay associated with the RYTHMIQ algorithm. The usual triggers for PMT were also observed (PVC 16%, PAC 9%). The remainder of the episodes (20%) in RYTHMIQ patients and most episodes of AV-block (66%) and CRT patients (74%) were incorrectly diagnosed as PMT during sinus tachycardia at the maximal tracking rate. The inappropriate intervention of the algorithm during exercise causes non-conducted P-waves, loss of CRT (sustained in six patients) and may have been pro-arrhythmogenic in one patient (induction of ventricular tachycardia). Conclusion: Algorithms to minimize ventricular pacing can occasionally have unintended consequences such as PMT. The PMT algorithm in Boston Scientific devices is associated with a high rate of incorrect PMT diagnosis during exercise resulting in inappropriate therapy with non conducted P-waves, loss of CRT and limited risk of pro-arrhythmic events.
Original languageEnglish
Pages (from-to)522-529
JournalJournal of Electrocardiology
Issue number4
Publication statusPublished - 2016


  • Clinical: implantable devices - pacemaker-bradyarrhythmias
  • Clinical: implantable devices - biventricular pacing/defibrillation
  • Clinical: implantable devices - ventricular tachycardia/fibrillation
  • Clinical: implantable devices - physiologic pacing
  • Clinical: cardiac mapping - electrogram analysis


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