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Europace Advance Access originally published online on July 31, 2007
Europace 2007 9(11):1062-1063; doi:10.1093/europace/eum163
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

ICDS

Anti-tachycardia pacing for ventricular tachycardia: good even after being bad

Miguel A. Arias*, Alberto Puchol, Eduardo Castellanos and Luis Rodríguez-Padial

Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo 45005, Spain

Manuscript submitted 24 June 2007. Accepted after revision 11 July 2007.

* Corresponding author: Dr. Miguel Ángel Arias, Avda. de Europa 3, Escalera 2, 3°C, 45005 Toledo, Spain. Tel: +34 637463857; fax: +34 925265492. E-mail address: maapalomares{at}secardiologia.es

Implantable cardioverter-defibrillators (ICDs) include anti-tachycardia pacing (ATP) and high-energy shocks (HES) for terminating ventricular tachyarrhythmias. ATP effectively terminates 85–90% of ventricular tachycardia episodes minimizing the disadvantages of HES. Acceleration to a faster arrhythmia with ATP may occur in 1–5% of episodes and the possibility for this complication is directly related to various factors such as the spontaneous ventricular tachycardia cycle length, the nature of the arrhythmogenic substrate, the use of anti-arrhythmic drugs, and the specific ATP protocol applied. HES are the preferred modality of treatment for very fast ventricular tachyarrhythmias resulting in haemodynamic deterioration. Since many episodes detected as ventricular fibrillation by ICDs are fast monomorphic ventricular tachycardias, some new ICD models have implemented the possibility of delivering ATP within the ventricular fibrillation zone, whereas the capacitors are being charged and before the HES is delivered. Figure 1 illustrates how a slow monomorphic ventricular tachycardia (420 ms) is accelerated after a single ramp of pacing to a faster arrhythmia (270 ms) that was detected by the ICD within the ventricular fibrillation zone. The ‘good behaviour’ was that the latter arrhythmia was interrupted by a burst of pacing delivered immediately after ventricular fibrillation detection at the time the capacitors had began to charge to deliver a HES.


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  		Figure 1 Panel A shows an episode of spontaneous ventricular tachycardia that is accelerated after a single ramp of pacing (15 impulses, 91% tachycardia cycle length). The fast ventricular tachycardia is detected into the ventricular fibrillation zone but a programmed single burst of pacing (8 impulses, 88% tachycardia cycle length) during charging the capacitors terminates the episode before a high-energy shock is delivered. Panel B shows in detail the termination of the episode as a result of anti-tachycardia pacing in ventricular fibrillation zone.

 

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This Article
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