Permanent radiofrequency ventricular pacing for management of drug-resistant ventricular tachycardia

Three patients with frequent episodes of symptomatic, sustained ventricular tachycardia that often required physician intervention were treated with a permanent patient-activated radiofrequency ventricular pacemaker for self-termination of ventricular tachycarida. Before pacemaker implantation, electrophysiologic testing revealed the tachycardia to be resistant to all approved and several investigational antiarrhythmic drugs. In all three patients, ventricular tachycardia was reliably and reproducibly terminated with brief bursts of rapid right ventricular apical pacing over several hundred trials. No patient had rapid ventricular pacing-induced acceleration of ventricular tachycardia or pacing-induced ventricular fibrillation. Since the implantation of a radiofrequency ventricular pacemaker an average of 13.7 months ago, all episodes of ventricular tachycardia (average 43/patient) have been terminated successfully by radiofrequency pacing, and no patient has required hospitalization for an arrhythmia-related problem.