Ventriculoatrial synchrony induced heart failure

Stefan Andric, Dragica Tesic, Dalibor Somer, Ilija Srdanovic, Tatjana Miljkovic, Djordje Jakovljevic, Lazar Velicki

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


OBJECTIVE AND IMPORTANCE:Endless loop tachycardia or pacemaker-mediated tachycardia, and atrioventricular desynchronization arrhythmia or repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are two forms of reverse impulse conduction - ventriculoatrial (VA) synchrony. Although VA synchrony can theoretically cause aggravation of heart failure, clinical cases describing severe consequential heart failure are lacking. CLINICAL PRESENTATION AND INTERVENTION:We describe a case of a 60-year-old patient who underwent primary percutaneous coronary intervention and mitral valve surgery. Implantation of a two-chamber pacemaker was also performed during the same hospitalization due to development of third-degree atrioventricular block. Ten months later, he presented with a severe form of heart failure with a significant reduction of left ventricular ejection fraction (LVEF). The atrial lead was displaced and VA synchrony was registered (RNRVAS-like condition). The pacemaker was reprogrammed and VA synchrony induced heart failure was successfully resolved. Echocardiographic follow-up showed improvement in LVEF. CONCLUSION:Ventriculoatrial conduction can be present even when the patient has a complete atrioventricular block. Atrial lead displacement and consequently loss of atrial capture with preserved sensing can be a predisposing factor for initiation of ventriculoatrial synchrony. Permanent ventriculoatrial synchrony may provoke aggravation of heart failure.
Original languageEnglish
Pages (from-to)439-443
Number of pages5
JournalActa Clinica Belgica
Issue number6
Early online date21 Feb 2018
Publication statusPublished - 2018
Externally publishedYes


  • Heart failure
  • pacemaker
  • lead displacement
  • complication
  • ECG


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