{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:41Z","timestamp":1753876241742,"version":"3.41.2"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T00:00:00Z","timestamp":1641686400000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Sharpe-Strumia Research Foundation","award":["SRF2021-03"],"award-info":[{"award-number":["SRF2021-03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Atrial dissociation (AD) is described as the existence of two simultaneous electrically isolated atrial rhythms. Theoretically, detection of dual atrial rhythms with a sufficiently high rate by pacemaker can lead to automatic mode switching and associated pacemaker syndrome. Such a clinical observation has not been reported before in the literature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 87-year-old female with Ebstein\u2019s anomaly status post-tricuspid valve annuloplasty and tricuspid valve replacement and a dual-chamber pacemaker presented with congestive heart failure 1 week after undergoing atrial lead revision. Interrogation of her dual-chamber pacemaker revealed two atrial rhythms: sinus or atrial-paced rhythm and electrically isolated atrial tachycardia (AT). Sensing of both atrial rhythms by the pacemaker led to automatic mode switching, which manifested as ventricular paced rhythm with retrograde P waves on electrocardiogram. Adjusting the atrial lead sensitivity to a level higher than the sensing amplitude of AT restored atrial paced and ventricular sensed rhythm, which resulted in resolution of heart failure symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Regardless of the cause of AD, there must be electrical insulation between the two rhythms for their independent coexistence in the atria. Atrial dissociation can lead to pacemaker syndrome from automatic mode switching. If the sensing amplitude during sinus rhythm is significantly larger than that of AT, adjusting the atrial lead sensitivity would solve the issue, as in the present case. Otherwise, atrial lead revision, pharmacotherapy, or AT ablation should be considered.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab531","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T13:52:30Z","timestamp":1641995550000},"source":"Crossref","is-referenced-by-count":1,"title":["Dual atrial rhythms: a case report of an unusual cause of pacemaker syndrome"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4134-0004","authenticated-orcid":false,"given":"Natee","family":"Sirinvaravong","sequence":"first","affiliation":[{"name":"Lankenau Medical Center, Main Line Health, Department of Cardiology, 100 E Lancaster Ave, Wynnewood, PA 19096, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Heimann","sequence":"additional","affiliation":[{"name":"Lankenau Medical Center, Main Line Health, Department of Cardiology, 100 E Lancaster Ave, Wynnewood, PA 19096, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Liskov","sequence":"additional","affiliation":[{"name":"Lankenau Medical Center, Main Line Health, Department of Cardiology, 100 E Lancaster Ave, Wynnewood, PA 19096, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3118-5680","authenticated-orcid":false,"given":"Gan-Xin","family":"Yan","sequence":"additional","affiliation":[{"name":"Lankenau Medical Center, Main Line Health, Department of Cardiology, 100 E Lancaster Ave, Wynnewood, PA 19096, USA"},{"name":"Fuwai Huazhong Hospital, 1 Fuwai Boulevard, Zhengzhou, Henan 451450, China"},{"name":"Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,1,9]]},"reference":[{"key":"2022011821312428300_ytab531-B1","doi-asserted-by":"crossref","first-page":"e018241","DOI":"10.1161\/JAHA.120.018241","article-title":"Inter\/intra-atrial dissociation in patients with maze procedure and its clinical implications: pseudo-block and pseudo-ventricular tachycardia","volume":"9","author":"Do","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2022011821312428300_ytab531-B2","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/j.1542-474X.2011.00433.x","article-title":"P-wave rejection in a transplanted heart","volume":"16","author":"Lowery","year":"2011","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"2022011821312428300_ytab531-B3","doi-asserted-by":"crossref","first-page":"420","DOI":"10.7326\/0003-4819-103-3-420","article-title":"The pacemaker syndrome","volume":"103","author":"Ausubel","year":"1985","journal-title":"Ann Intern Med"},{"key":"2022011821312428300_ytab531-B4","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2022011821312428300_ytab531-B5","first-page":"195","article-title":"New concepts in pacemaker syndrome","volume":"4","author":"Farmer","year":"2004","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2022011821312428300_ytab531-B6","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1161\/CIRCULATIONAHA.117.028373","article-title":"An asymptomatic man with an abnormal ECG","volume":"136","author":"Brenes","year":"2017","journal-title":"Circulation"},{"key":"2022011821312428300_ytab531-B7","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.hrcr.2018.12.010","article-title":"Inadvertent atrial dissociation following catheter ablation: a demonstration of cardiac anisotropy and functional block","volume":"5","author":"Jain","year":"2019","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - 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