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Permanent antitachycardia pacemaker therapy for ventricular tachycardia.
D M Newman1, M A Lee, J M Herre
1Department of Medicine, University of California, San Francisco 94143-0214.
Pacing and Clinical Electrophysiology : PACE
|August 1, 1989
Summary
Antitachycardia pacing, combined with an automatic implantable cardioverter defibrillator (AICD), effectively treats ventricular tachycardia. This combination therapy offers safety and successful pace termination for refractory cases.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Ventricular tachycardia (VT) poses a significant risk, often requiring advanced treatment strategies.
- Medically refractory VT necessitates innovative therapeutic approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of antitachycardia pacing (ATP) alone or combined with an automatic implantable cardioverter defibrillator (AICD).
- To assess device-device interactions and patient outcomes in VT management.
Main Methods:
- Retrospective analysis of 11 patients with VT treated with ATP (N=3) or ATP + AICD (N=8).
- Devices were programmed for automatic ATP, magnet-activated ATP, or tachycardia detection with bradycardia support.
- Follow-up included monitoring for VT termination, AICD discharges, and adverse events.
Main Results:
- Seven of nine patients with automatic ATP achieved successful VT termination (up to 120 times/month).
- Two deaths occurred due to heart failure; four AICD discharges were recorded in three patients.
- Inadvertent AICD discharges occurred in two cases due to rate cutoffs <200 bpm and device interactions.
Conclusions:
- Antitachycardia pacing, especially when combined with AICD, is an effective treatment for medically refractory ventricular tachycardia.
- Careful programming of AICD rate cutoffs and lead positioning are crucial to avoid adverse device-device interactions.
- This combined approach provides a safe and effective therapeutic option for complex VT cases.