Clinical significance of RNRVAS
RNRVAS attacks are triggered by sensor driven heart rate increase, as in our patient who experienced RNRVAS at low heart rates (Figure 4)3,4,7. The fact that RNRVAS is triggered very easily during atrial threshold tests necessitates re-evaluation of the general approach to RNRVAS. Sharma et al 8 propose four clinical scenarios in case of RNRVAS: (i) pacemaker syndrome as a result of loss of AV synchronization, (ii) unnecessary increase in ventricular pacing ratio, (iii) false AHRE diagnosis, (iv) mode switch due to false AHRE diagnosis and pro-arrhythmia. In the same study, the possibility that false AHRE diagnosis may lead to unjustified anticoagulant use and device programming is underlined. False AHRE diagnosis may also lead to unnecessary anti-arrhythmic medicine usage and ablations.