Arrhythmias induced during termination of supraventricular tachycardia

Pacing is being used frequently for the treatment of drug-resistant, paroxysmal supraventricular tachycardias (SVT). SVT can usually be terminated by pacing, but arrhythmias may be induced which interfere with the safety of antitachycardia pacing. To quantify these pacing-induced arrhythmias, 453 attempts to terminate SVT in 111 patients were analyzed. The patients were 6 to 73 years old (mean 41); 62 were male. Seventy-six patients had SVT using an accessory atrioventricular bypass, and 35 patients had intranodal SVT. Single and then, if required, multiple ventricular and atrial premature beats and overdrive pacing were delivered from the atrium and ventricle. A pacing-induced arrhythmia occurred in 9% of all attempts (34% of patients). Atrial flutter or fibrillation (AF) was the most frequent arrhythmia (in 8% of all attempts and sustained in 75%). Atrial vs ventricular pacing resulted in a 12% vs 2% incidence of AF. AF was unrelated to age, sex, atrial size and SVT type, and was predominantly induced by multiple premature beats. In 6 patients a different SVT and in 2 patients a nonsustained ventricular tachycardia was induced. In 6 patients SVT could only be terminated by initiating another arrhythmia. Thus, AF is frequently induced during attempted pacing termination of SVT. To limit the risk of AF, a single premature beat should preferentially be used to terminate SVT. In 6% of patients, SVT can only be terminated by inducing another arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)