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Europace Advance Access published online on July 9, 2008
Europace, doi:10.1093/europace/eun176
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

CASE REPORT

Short–long–short sequence caused by ventricular safety pacing inducing ventricular tachycardia in a patient with a dual-chamber implantable cardioverter defibrillator

Meiso Hayashi, Seiji Takatsuki, Anne Messali, Paul Milliez, Fabrice Extramiana and Antoine Leenhardt*

Cardiology Department, Lariboisière Hospital, Paris 7 University, 2 Rue Ambroise Paré, 75475 Paris Cedex 10, France

Ventricular safety pacing (VSP) is an algorithm used to prevent crosstalk inhibition and ventricular capture during the vulnerable period. We report a 78-year-old man with implantable dual-chamber defibrillator, in whom clusters of ventricular tachycardias (VTs) were provoked by the VSP. During rapid DDDR pacing, the delivery of the VSP after every other atrial-paced beat resulted in short–long–short ventricular sequences and induced VTs. An atrial-based lower rate timing, long atrioventricular pacing interval, and automatic gain control also accounted for this arrhythmogenic ventricular sequence. The VSP and the subsequent VT were eliminated by decreasing the pacing rate.

* Corresponding author. Tel: +33 1 49 95 82 23; fax: +33 1 49 95 82 06. E-mail address: antoine.leenhardt{at}lrb.aphp.fr

Manuscript submitted 25 March 2008. Accepted after revision 11 June 2008.


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