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  • Title: Importance of modes of electrical termination of ventricular tachycardia for the selection of implantable antitachycardia devices.
    Author: Waldecker B, Brugada P, Zehender M, Stevenson W, Den Dulk K, Wellens HJ.
    Journal: Am J Cardiol; 1986 Jan 01; 57(1):150-5. PubMed ID: 3942060.
    Abstract:
    Different implantable systems for electrical treatment of ventricular arrhythmias are available. Information about mode of termination of ventricular tachycardia (VT) helps to select the most appropriate electrical treatment for drug-resistant VT. During 158 electrophysiologic studies, the mode of termination of 215 episodes of VT was analyzed in 2 groups of patients. Group 1 consisted of 54 patients with documented monomorphic VT and group 2 of 46 patients with other documented or suspected ventricular arrhythmias. Eighty-two patients had coronary heart disease, 8 had other structural heart disease and 10 had idiopathic VT. Termination of VT was attempted using extrastimuli and overdrive pacing; direct-current (DC) shocks were given in case of syncopal VT. During 33 of 96 studies (34%) in group 1, DC shock was required to interrupt VT, compared with 45 of 62 studies (73%) in group 2 (p less than 0.001). This difference was a result of less frequent induction of immediately syncopal VT in group 1 (14 of 129 VTs, vs 40 of 86 in group 2, p less than 0.001). Non-syncopal VT could reliably and safely be terminated by pacing in 61%, irrespective of the clinical arrhythmia. Pacing-induced acceleration of VT occurred in 6% (single extrastimuli) to 36% (over-drive pacing) (mean 26%) of attempts. Subsequent DC shock was required in half of these cases. Immediate collapse after induction of VT was not related to the presence of heart disease, but was related to a combination of VT cycle length (shorter than 260 ms) and left ventricular ejection fraction (less than 40%). Antiarrhythmic drugs reduced the need for DC shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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