Clinical usefulness of chest wall stimulation in patients with automatic tachycardia-terminating pacemakers

Chest wall stimulation may be used diagnostically and therapeutically in the follow-up of patients with automatic tachycardia-terminating pulse generators. In this report, we present our experience with chest wall stimulation in the follow-up of five patients with implanted Intermedics CyberTach 60 automatic tachycardia-terminating pacemakers (three for supraventricular tachycardia and two for ventricular tachycardia). Chest wall stimulation delivered at a rate faster than the rate detection criterion of the pulse generator often precipitates reentry tachycardia, making it possible to perform a noninvasive electrophysiologic study. In addition, chest wall stimulation may be invaluable in the termination of reentry tachycardia which is unsensed by an implanted pulse generator either because the rate is too slow, or below the rate detection criterion, or because the intracardiac signal does not attain the sensitivity of the pulse generator.