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Programmable External Automatic Antitachycardia Pacing as a Bridge to Definitive Therapy in Patients with Recurrent Sustained Ventricular Tachycardia
Author(s) -
AHERN THOMAS S.,
NYDEGGER CHARLES,
GREENSPON ARNOLD J.,
KIDWELL GREGORY A.,
HESSEN SCOTT E.,
MCCORMICK DANIEL J.,
KUTALEK STEVEN P.
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb03137.x
Subject(s) - medicine , cardioversion , cardiology , ventricular tachycardia , tachycardia , ejection fraction , ventricular fibrillation , defibrillation , anesthesia , atrial fibrillation , heart failure
The efficacy and safety of external programmable automatic antitachycardia pacemakers (ATPs) used in the critical care setting for recurrent sustained monomorphic ventricular tachycardia (VT) was evaluated. Ten patients who had failed a mean of 4.0 ± 1.4 antiarrhythmic medications (range 2–7) and who had previously required electrical cardioversion for VT were enrolled. Prior to ATP use, successful overdrive pacing termination of VT was demonstrated in all patients. Intertach TM (lntermedics, Inc.; n = 9) and Orthocor R II (Cordis, Inc.; n = 1) ATPs were attached to temporary bipolar transvenous or epicardial pacing leads. Mean patient age was 66.4 ± 11.5 years, and mean left ventricular ejection fraction was 22 ± 7.5%. At the time of initial ATP use, mean VT cycle length was 347 ± 88 msec (range 280‐550 msec). A burst scanning antitachycardia pacing algorithm was used in each patient; one patient was also treated with a fixed rate burst adapted to VT cycle length. The duration of ATP use ranged from 2–25 days (median 5), successfully terminating < 3,369 VT episodes (median 3, range 0 to < 3,103 episodes per patient). Two episodes of ATP induced rate acceleration occurred, each successfully terminated by the ATP. Only two patients required external cardioversion during ATP use, one for primary ventricular fibrillation and one for rapid polymorphic VT associated with antiarrhythmic drug withdrawal. ATPs also provided antibradycardia pacing and allowed for serial programmed ventricular stimulation. No complications were associated with transvenous catheter or ATP use. Temporary use of external ATPs acted as a bridge to definitive antiarrhythmic measures: endocardial resection (n = 2), defibrillator implant (n = 2), chronic amiodar‐one therapy (n = 4), electrophysiologically guided antiarrhythmic therapy (n = 1), and cardiac transplantation (n = 1). Thus, temporary automatic antitachycardia pacing provides a safe, rapid, and effective means of VT termination in a critical care setting, with a low frequency of tachyarrhyfhmia rate acceleration, enabling its use as a bridge to definitive treatment for sustained VT.