Ventricular Tachycardia Precipitated by Short-long-short Sequence in a Patient with Implantable-cardioverter Defibrillator

Diego Chemello, Anandaraja Subramanian, Sheila Watkins, Douglas Cameron
2012 Indian Pacing and Electrophysiology Journal  
Abrupt changes in heart rate, particularly short-long-short sequences in the ventricular cycle length (CL), might precede initiation of ventricular tachycardia/fibrillation (VT/VF). These changes may be facilitated or caused by pacing activity in patients with pacemakers or implantable-cardioverter defibrillators (ICDs). We describe a patient with two episodes of acquired VT precipitated by short-long-short sequences and diagnosed from the ICD recordings. In such cases, the knowledge of the
more » ... nowledge of the device parameters is extremely important for a correct diagnosis and management. A 59-years-old man with nonischemic dilated cardiomyopathy was admitted to the Emergency Department after receiving a shock from his ICD, which was preceded by dizziness. The dualchamber ICD (Medtronic EnTrust, Minneapolis, MN, USA) was implanted two years earlier for primary prevention of sudden cardiac death. At the time of device implantation, patient was in sinus rhythm with normal PR interval (170 ms) and therefore it was programmed to AAI+ mode (MVP™) at 60 bpm. Therapies were programmed as follows: 1) VT zone at 176 bpm: anti-tachycardia pacing (ATP) (Burst x3, Ramp x2), followed by shock (30J, 35J x3); 2) VF zone at > 200 bpm: shock (30J, 35J, 35J x4) with ATP During Charging™.
doi:10.1016/s0972-6292(16)30461-2 fatcat:tvrf3x4oarhzvej25gqlcbybva