Antitachycardia Pacing for Ventricular Tachycardia Using Implantable Cardioverter Defibrillators

Michael O. Sweeney

Disclosures

Pacing Clin Electrophysiol. 2004;27(9) 

In This Article

Introduction

Antitachycardia pacing (ATP) refers to the use of pacing stimulation techniques for termination of tachyarrhythmias. Such techniques can be automatically applied using implantable cardioverter defibrillators (ICDs) and offer the potential for painless termination of ventricular tachycardia (VT). Reduction in painful shocks may improve patient quality-of-life (QOL) and extend ICD pulse generator longevity. Numerous older studies have consistently demonstrated that ATP can reliably terminate ~ 85%-90% of slow VT (cycle lengths [CL] < 300-320 ms) with a low risk of acceleration (1%-5%).[1] More recently similar high success and low acceleration rates for fast VT (CL 320-240 ms) have been demonstrated. These observations have repositioned the ICD as primarily an ATP device with defibrillation backup only as needed.

Tachycardias that require reentry to persist, are susceptible to termination with pacing. The sine-qua non of a reentrant arrhythmia is the ability to reproducibly initiate and terminate the tachycardia by critically timed extrastimuli.[2] Therefore, the possibility of successful termination of tachycardias with pacing can be anticipated on the basis of the mechanism. It is therefore useful to consider the origin of ventricular tachycardias that are commonly encountered in the ICD patient population.

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