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His bundle ablation for supraventricular arrhythmias to avoid spurious shocks of an implanted defibrillator
L Jordaens1, A Caenepeel, P Calle
1Department of Cardiology, University Hospital Ghent, Belgium.
Insights
This study presents a case of managing atrial fibrillation in an implantable cardioverter-defibrillator (ICD) patient. AV node ablation successfully managed shocks, even with recurrent AV conduction.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Managing atrial fibrillation with fast ventricular response in implantable cardioverter-defibrillator (ICD) patients is challenging.
- Patients with dilated cardiomyopathy and recurrent cardiac arrest require careful arrhythmia management.
Observation:
- A patient with dilated cardiomyopathy experienced recurrent cardiac arrest due to ventricular arrhythmias.
- AV node ablation with low-energy shocks and pacemaker implantation preceded ICD insertion.
- The patient later experienced recurrent AV conduction with slow ventricular rates, leading to ICD shocks.
Findings:
- Pacemaker interaction and ventricular arrhythmias were excluded as causes for the ICD shocks.
- Electrophysiologic study revealed persistent second-degree heart block after atrial fibrillation conversion.
- These findings indicate atrial arrhythmias were not the cause of the shocks.
Implications:
- AV node ablation can be an effective strategy for managing ICD shocks in select patients with complex arrhythmias.
- This approach may improve patient outcomes and reduce inappropriate shocks.
- Further research is needed to explore the long-term efficacy and safety of this intervention.
Abstract:
Atrial fibrillation with fast ventricular response remains a matter of concern in patients treated with an implantable cardioverter defibrillator (ICD). A patient with dilated cardiomyopathy, suffering from atrial arrhythmias and recurrent cardiac arrest due to both ventricular tachycardia and ventricular fibrillation, is presented. Ablation of the AV node by means of low-energy direct-current shocks with subsequent pacemaker implantation was performed before ICD implantation. The patient received shocks after four months, when he had recurrence of AV conduction with a slow ventricular rate. Pacemaker interaction was excluded, and no short ventricular arrhythmias were observed. During electrophysiologic study after electrical conversion of atrial fibrillation, persistent second degree heart block was documented, giving further evidence that atrial arrhythmias were not responsible for the shocks. The patient's functional status remains good after more than 18 months of follow-up.