Transcutaneous Cardiac Pacing for Termination of Tachyarrhythmias (original) (raw)

Treatment of Ventricular and Supraventricular Tachyarrhythmias by Transcutaneous Cardiac Pacing

Pacing and Clinical Electrophysiology, 1989

ALTAMURA, G., ET AL.: Treatment of Ventricular and Supraventricular Tachyarrhythmias by Transcutaneous Cardiac Pacing. The efficacy of noninvasive transcutaneous cardiac pacing (TCP) in the treatment of tachyarrhythmic events was tested in 24 patients: 14 with ventricular tachycardia, seven with supraventricular tachycardia and three with atrial flutter. Six (42.9%) ventricular tachycardias were interrupted: in two of the ten patients on whom underdrive pacing was attempted and in ail four cases in which overdrive stimulation was possible. Five of the six supraventricuiar tachycardias utiiizing an atrioventricuJar bypass tract were interrupted, while the TCP was unsuccess/ui on the only patient with atrioventricuJar nodaJ reentrant tachycardia. TCP failed to interrupt the arrhythmia in the three cases of atrial flutter. No clinically significant untoward efects (in particular tachycardia acceleration or ventricular /ibriilation) were observed, except for a tolerable thumping sensation on the chest during pacing. In four patients, TCP effects on cardiac activation was evaluated by endocavitary recording: while the mean ventricular threshold was 70 mA, atrial capture was possible on only two patients at a current intensity of 140 and 150 mA. We consider our preliminary experience with TCP in the treatment of tachycardias encouraging. The technique was easily and rapidly usable and it was immediately successful in the majority of atrioventricular reentrant tachycardias and in a relevant percentage of ventricular tachycardias. In this latter setting TCP was mostly effective in the slower tachycardias where overdrive pacing was possible. A further experience with devices provided by higher pacing rales is warranted. (PACE, Vol. 12, February 1989) transcutaneous cardiac pacing, noninvasive pacing, lachyarrhj^hmias, electrical treatment

Safety and Efficacy of Pacing for Ventricular Tachycardia

Pacing and Clinical Electrophysiology, 1986

HOLLEY, L.K., ET AL.: Safety and efficacy of pacing for ventricular lachycardia. This study was undertaken to determine the safety and efficacy of three different pacing modalities on the termination of ventricular tachyarrhythmias. Thirly-livo patients were studied in (he eJectrophysioiogy laboratory. Three randomized pacing modalities were selected for attempted conversion: auto increment, auto burst, and random burst. In all three groups, arrhythmias with cycle lengths shorter than 230 ms required DC shock, with one exception. Those longer than 230 ms were terminated by pacing in 85% of cases. There was a 15% rate of acceleration. Thus, antitachycardia pacing for ventricular tachyarrhythmias should be considered only with dejibriilating back-up. (PACE. Vol. 9, November-December. Pari II, 7986) antitachycardia pacing, de/ibrilla(ion diac death. A partially fulfilled promise. N. Eng/. /. Med., 310:255-257. 1984. 3. Echt, D.S., Winkle. R.A.: Management of patients with the automatic cardioverter/defibrillator. CJin.

Transcutaneous Cardiac Pacing: Evaluation of Cardiac Activation

Pacing and Clinical Electrophysiology, 1990

ALTAMURA, G., ET AL.: Transcutaneous Cardiac Pacing: Evaluation of Cardiac Activation. The effects of transcutaneous cardiac pacing (TCP) on cardiac activation were evaluated by endocavitary recording (HRA, RVA) in eight patients, in order to test the possibility to obtain a simultaneous atrial and ventricular stimulation. The transcutaneous pacemaker used was the Pace Aid 52 [pacing rate 50-160 ppm, current output 10-150 mA, pulse width 20 sec). The two skin electrodes [surface area 50 cm') were placed on the chest in anteroposterior position. Ventricular capture was observed in all patients [threshold = 74 2 14 mA), simultaneous atrial capture was obtained in onlyfour cases (threshold = 138 k 25 mA). In conclusion, our data show that four-chamber simultaneous stimulation by TCP is possible, but only with pacing energies much higher than those usually required to capture the ventricle. The ability of TCP to simultaneously pace the atria and ventricles, though not relevant in the emergency cardiac stimulation for symptomatic severe bradyarrhythmias, could be useful in the treatment of reentrant supraventricular tachycardias. [PACE, Vol. 13, December, Part I1 1990) I transcutaneous cardiac pacing, external pacing, noninvasive pacing, cardiac activation

Long-Term Results of Antitachycardia Pacing in Patients with Supraventricular Tachycardia

Pacing and Clinical Electrophysiology, 1989

Results of Antitachycardia Pacing in Patients with Supraventricular Tachycardia. Between 1979 and 1984 the Cybertach-60, {Intermedics, Inc. Model 262-01}, a programmable, automatic antitachycardia pacemaker was implanted in 31 patients who had drug-re/ractory supraventricular tachycardia (SVTJ. The patients have been followed for a total of 64-108 (mean 84 months). All patients were symptomatic and had /ailed two or more drugs and six patients had required prior DC cardioversion. The mechanism o/supraventricuJar tachycardia was atrioventricular (AV) nodal reentry in six patients, AV reentry in four patients, and atrial tachycardia in one patient. Preoperatively all patients had reJiable termination of the tachycardia without induction of atrial jibriliation by pacing methods available to Cybertach-60. Postimplant, Cybertach-60 reliably terminated all episodes o/tachycardia without ancillary drug therapy. Nevertheless, at iong-term foUow-up antitachycardia pacing was effective and safe in the minority (36%}. with only four patients out of eleven still using a pacemaker for supraventricu/ar tachycardia. One of these four patients required additional drug therapy. In one of the patients, the Cyhertach-60 was replaced after 78 months by a more advanced device, (Intertach, Intermedics, Inc.) because of a depleted Cybertach-60 battery. In seven patients who no longer use antitachycardia pacing for termination of tachycardia, one patient developed atrial jibrilJation during tachycardia termination (at 58 months postimplant). Three patients experienced induction of tachycardia or atrial ^briiiation by the pacemaker due to undersensing of sinus P waves (at 36, 48, and 51 months}. One patient had inappropriate rate detection while in sinus rhythm triggering the tachycardia termination burst from the pacemaker and subsequent SVT induction. Although pace termination of supraventricuJar tachycardia was effective in two patients, they chose elective ablation (AV nodal and accessory pathway, respectively, at 74 and 6 months) due to frequent symptomatic SVT. (PACE, VoJ. 12, fune 1989} antitachycardia pacing, supraventricular tachycardia Address for reprints: Ingela Schntttger, M.D., Cardiology Divi-i r L i sion.

The Treatment of Ventricular Tachycardia Using an Automatic Tachycardia Terminating Pacemaker

Pacing and Clinical Electrophysiology, 1981

The treatment of ventricuiar tachycardia using an automatic tachycardia terminating pacemaker. Implanted cardiac pacemakers may be used in the management of selected patients with ventricuJar tachycardia unresponsive to other forms of medico/ and surgical therapy. We wouJd like to report tbe successfuJ treatment of such a patient utilizing a new muitiprogrammable automaticaliy activating ventricuiar burst pacemaker. Thorough eJectrophysiologic study preceded implantation, and was instrumental in choosing an effective terminating technique, in identifying the need for adjunctive drug therapy, and in testing (he safety and efficacy of the implanted system. (PACE, Vol. 4, September-October, 1981} ventricuiar tachycardia, tachycardia termination, pacemaker termination, antitachycardia pacemaker, programmed stimulation Programmed electrical stimulation for initiation and termination of ventricular tachycardia has been repeated by several investigators.'"* Despite improvements in the management of patients with recurrent sustained ventricular tachycardia, there are still those for whom no effective pharmacologic or surgical therapy can be identified. In such patients chronically implanted pacemakers capable of arrhythmia recognition and termination might be an alternative therapy if a safe, effective system were available. We have previously reported the Address for reprints: Jerry C. Griffin, M.D., Section in Cardiology.