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.