Quiet timer blanking in a dog with sick sinus syndrome and a permanent transvenous pacemaker

• Published in: Journal of veterinary cardiology 2021-12, Vol.38, p.36-43
• Main Authors: Crooks, A.V., Gelzer, A.R., Oyama, M.A., Kraus, M.S.
• Format: Article
• Language: English
• Subjects: Animals; Arrhythmias, Cardiac - therapy; Arrhythmias, Cardiac - veterinary; Asynchronous pacing; Cardiac Pacing, Artificial - veterinary; Dog Diseases - diagnosis; Dog Diseases - therapy; Dogs; Electrocardiography - veterinary; Male; Noise reversion; Pacemaker, Artificial - veterinary; Sick Sinus Syndrome - therapy; Sick Sinus Syndrome - veterinary; Syncope - veterinary; Undersensing
• ISSN: 1760-2734; 1875-0834
• DOI: 10.1016/j.jvc.2021.10.001

A 14-year-old, 5.8 kg (12.7 lb) male castrated Jack Russell Terrier was referred for investigation of syncope and an arrhythmia. Electrocardiogram showed pronounced variation in the sinus rate including long periods of sinus arrest and an inconsistent escape rhythm. Sick sinus syndrome was the presumptive diagnosis. A single lead permanent transvenous pacemaker was implanted and was programmed to perform ventricular-demand pacing. Postoperative pacemaker interrogation revealed undersensing and asynchronous pacing during episodes of supraventricular tachycardia (SVT). This intermittent pacemaker malfunction was attributed to a specific pacemaker programming feature called quiet timer blanking. Adjustment of pacemaker parameters did not restore normal function. Treatment with sotalol (5 mg per os q 12 h) was used to medically treat the SVT, and asynchronous pacing was not observed during follow-up visits. To the authors’ knowledge, this is the first documented case of quiet timer blanking causing paroxysmal undersensing and asynchronous pacing in a dog with a permanent pacemaker.