{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:27:37Z","timestamp":1753878457043,"version":"3.41.2"},"reference-count":8,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to define and explain a novel form of pacemaker\u2010mediated arrhythmia which is initiated and sustained by atrial capture loss coinciding with ventriculoatrial (VA) conduction within the postventricular atrial refractory period (PVARP). Unlike repetitive nonreentrant VA synchrony (RNRVAS), in the pseudo\u2010RNRVAS, the atrium is not stimulated due to pacing below the threshold level, rather than because of refractory atrial myocardium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to elucidate the mechanisms of this pseudo\u2010RNRVAS, identify predisposing factors, and propose preventive strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010one patients with dual\u2010chamber cardiac implantable electronic devices (CIEDs) exhibiting stable VA conduction within the PVARP were included. Pseudo\u2010RNRVAS were induced by altering atrial amplitude and lower rate interval while keeping other CIED parameters constant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pseudo\u2010RNRVAS developed after atrial capture loss in 20 out of 21 patients. Notably, 11 patients experienced pseudo\u2010RNRVAS at heart rates \u2264\u200970\u2009bpm, and 7 patients at AV delay \u2264\u2009150\u2009ms. The condition initiated immediately following the first ventricular pace beat after atrial capture loss in 18 patients. In six cases, pseudo\u2010RNRVAS terminated intermittently and then restarted; in 14 cases, it did not resolve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pseudo\u2010RNRVAS can occur even at low heart rates and without specific predisposing factors seen in RNRVAS. Conditions that increase atrial pacing probability and threshold raise the likelihood of pseudo\u2010RNRVAS. Early postimplantation may pose a heightened risk, correlating with pacemaker syndrome and susceptibility to heart failure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/anec.70033","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T13:44:23Z","timestamp":1731937463000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Introducing a Novel Pacemaker\u2010Mediated Arrhythmia: The Pseudo\u2010<scp>RNRVAS<\/scp> Arising From Atrial Capture Challenges"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2653-0048","authenticated-orcid":false,"given":"Asli Inci","family":"Atar","sequence":"first","affiliation":[{"name":"Ankara Bilkent City Hospital  Ankara Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilyas","family":"Atar","sequence":"additional","affiliation":[{"name":"Ankara Guven Hospital  Ankara Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/17843286.2018.1443002"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.13033"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960140911"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540\u20108159.1997.tb05506.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00399\u2010017\u20100517\u2010z"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1009853723766"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.10.006"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.04.002"}],"container-title":["Annals of Noninvasive Electrocardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.70033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T11:59:40Z","timestamp":1732708780000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/anec.70033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":8,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1111\/anec.70033"],"URL":"https:\/\/doi.org\/10.1111\/anec.70033","archive":["Portico"],"relation":{},"ISSN":["1082-720X","1542-474X"],"issn-type":[{"type":"print","value":"1082-720X"},{"type":"electronic","value":"1542-474X"}],"subject":[],"published":{"date-parts":[[2024,11]]},"assertion":[{"value":"2024-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70033"}}