Clinical evaluation of an adaptive tachycardia intervention pacemaker with automatic cycle length adjustment

An external version of a new pacemaker designed for automatic tachycardia termination is described. In response to a tachycardia, defined as four successive beats occurring at a rate faster than a variable preset value, a number of stimuli (1-15) are generated. The initial coupling interval and subsequent pacing cycle intervals (where applicable) are always the same. Failure to terminate tachycardia results in the reduction of the pacing cycle length by 6 ms before termination of tachycardia is re-attempted. Pacing cycle length reduction may be repeated up to 16 times. If all coupling intervals of a single extrastimulus fail to achieve tachycardia termination, a second stimulus is scanned with the first through the same range of decrements. Additional stimuli, to a total of 15, could be used. A memory function is incorporated to retain and re-use a successful sequence. The pacemaker was evaluated in 16 patients with recurrent "supraventricular" (atrioventricular and intra A-V nodal) tachycardia, using right ventricular pacing. Termination was successful in all patients. More than two stimuli were necessary in only two patients, one of whom required five, and the other six stimuli. No unwanted arrhythmias were induced.