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To the Editor: Ullah and Stewart present a case of pacemaker-mediated tachycardia and described it as a ‘malfunction of dual chamber pacing’.1 However, I would contend that the pacemaker is functioning appropriately—that is, it is sensing atrial activity in the atrium and pacing (capturing) the ventricle. The problem in pacemaker-mediated tachycardia is the retrograde atrial activation beyond the postventricular atrial refractory period (PVARP) as described, and appropriate programming of the PVARP based on the VA conduction time (and/or the use of PVARP extension post-PVC) will minimise this problem. It should also be noted that the PVARP is a refractory period and not a ‘blanking period’ as erroneously described in the report. The differentiation of blanking and refractory periods is fundamental to the understanding of pacemaker programming, function and diagnostics.
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