Automatic pacemaker termination of two different types of supraventricular tachycardia (original) (raw)
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Management of Tachyarrhythmias with Dual-Chamber Pacemakers
Pace-pacing and Clinical Electrophysiology, 1983
Des stimulaleurs multiprogrammables AV séquentiels de type “double-demande” (DVI, MN) ont été implantés chez 23 patienls porteurs ?anomalies variées de tachycardies supraventriculaires. De plus, des stimuloteurs AV séquenfiels à paire “nonobligée” (DVI, MN e(DDD, M) ont été utilisés pour le traitement de lachyarhythmies ventriculaires. Nous avons observé que ľexpérience avec ee type de stimulateur multiprogrammable est favorable chez les patients sans fibrillation auriculaire chronique, qui ont besoin ?un stimutafeur et qui nécéssitent un froilement anti-tachycardique. Ľévolution des stimulateurs du type DDD contribuera sans doute à un traitement encore plus éfficace.Multi-programmable dual-demand AV sequential (DVI, MN) pacemakers were implanted in twenty-three potients (in one of them a DVI, MN unit was used as a VVI, MN with the aid of an atrial plug) with suproventricular tachycardias after electrophysiological studies revealed a great voriety of AV reentry circuits. The latter included tachycardios involving accessory pathways of the Kent type, manifest or concealed Wolff-Parkinson-White syndromes, nodo-ventricular (Mahaim) tracts, “enhanced” AV node for extra AV nodal) pothwaysand dual AV pathways. In addition, multiprogrammable “non-committed” AV sequential (DVI, MN and DDD, M) pacemakers were permanently implonted to treat different forms of ventricular tachyarrhythmias that included: torsode de pointes in the Romano-Ward syndrome and Chagas' cardiomyopathy, ventricular tachycordia which is bradycardia-dependent (in Chagas' cardiomyopathy) and reciprocal beats indueed by, and producing severe hemodynamic derangements in a patient with a conventional VVI unit. With smallsize multiprogrammable units, arrhythmias may be treated by changing parameters non-invasively. By temporary inhibition, one may analyze the underlying rhythm and pacemaker dependency. In potients without chronic atrial flutterJfibrillation who require pacing and possibly tachyarrhythmia control, our experience with multiprogrammable “non-committed” AV sequential pacing has been very satisfactory. The evolution toward newer pacing modes which provide atrial sensing and trackmg (DDD), and thus preserve AV synchrony over a wider range of atrial rates, may contribute even further to successful patient management. This may be applicable to pediatric patients as well.
Clinical Cardiology, 1982
A fully implantable automatic scanning pacemaker designed for tachycardia termination has been used in three patients with regular paroxysmal supraventricular tachycardia. The pacemaker recognizes tachycardia and delivers one or two extrastimuli which automatically scan inwards if tachycardia continues. A memory is incorporated to retain and immediately reuse a successful pacing sequence if tachycardia recurs. Ventricular pacing has been used in two patients and atrial stimulation in one. Although all had suffered frequent attacks of tachycardia after implantation no sustained episodes of tachycardia have been appreciated. No unwanted arrhythmias have been induced and drug treatment has been stopped in all three patients. Fully implantable scanning pacemakers which automatically recognize and revert tachycardia offer an effective and versatile form of treatment for recurrent paroxysmal tachycardias.
Pacing and Clinical Electrophysiology, 1990
Intertach 262-12 tachycardia reversion pulse generafor was implanted in 14 patients (six male, eight female, mean age at impianlation 45 ± 16 years) with recurrent symptomatic tachycardias. Six patients had atrioventricuiar (AV) nodal reentrant tachycardia, three patients had orthodromic tachycardia with Wolff-Parkinson-White syndrome, two had circus movement tachycardia via a concealed bypass tract, two had ventricular tachycardia, one patient had atrial flutter. Mean duration of symptoms be/ore implantation was 8 ± 4 years and mean number of antiarrhythmic drug trials was 3.5 ± 1. The primary tachycardia response mode consisted of autodecremental pacing in one patient, burst pacing in two patients, and adaptive scanning of the initial delay or burst cycle length in eleven patients. The secondary tachycardia response mode consisted of autodecremental pacing in four patients, burst pacing in three patients and burst scanning in four patients. Tachycardia response was automatic in all but one patient with ventricular tachycardia. During a follow-up period of 30.5 ± 10.6 months, one patient with ventricular tachycardia died from a nonarrhythmic cause, fieinterventions were necessary due to electrode fracture in one patient and due to pacemaker software defect in another one. Two patients underwent surgical care of their arrhythmia: one patient with atrial flutter and one patient with AV nodai reentry tachycardia, 24 months and 11 months postpacemaker implantation, respectively. Four patients required digitalis to prevent pacing induced atriai _ftbriliation. Other proarrhythmic effects were not encountered. The pacemaker proved to be a versatile system with reliable tachycardia detection and termination functions. It provided a valuable adjunctive therapy in these selected patients. (PACE, Vol. 13, July }990} antitachycardia pacing, supraventricular tachycardia, ventricular tachycardia
Pacing and Clinical Electrophysiology, 1980
decremental pacing-A microprocessor based modality for the termination of paroxysmal tachycardias. Five patients aged between 27 and 48 years were referred for investigation of recurrent paroxysmal tachycardias. Electrophysiologicai studies revealed concealed ventricuioatrial accessory pathways in two patients, possible atrionodal pathways in two patients and duai intranodaJ pathways in one patient. During electrophysiologicai study, particular attention was paid to methods of terminating tachycardia by pacing techniques including single or double atrial and ventricular extrastimuli, atrial or ventricular underdrive, atrial overdrive pacing, and in two patients, rapid ventricular pacing. 'Autodecremental' atrial pacing was employed in all five patients and autodecremental ventricular pacing in two patients. This system is controJJed by a microprocessor interfaced with a stimulator. When tachycardia of a cycle length less than 375 ms is sensed the system initiates pacing sequences. The initial stimulus is introduced at an interval less than the tachycardia cycle determined hy a preset deeremental value D. Each subsequent pacing interval is reduced by the value of D resulting in a gradual acceleration of pacing. The total duration of pacing is limited by the value of the pacing period [Pj. The final pacing rate is determined by P but cannot exceed 275 bpm (cycle length of 218 ms]. Both P and D are operator programmable variables. Tachycardias of a cycle length less than 218 ms do not activate the pacemaker. The postpacing sensing deadtime of the system is set at 50 ms. In three patients, double atrial extrastimuli or atriai overdrive initiated atrial flutter or fibrillation. Autodecremental atrial pacing was successful in converting tachycardia to sinus rhythm in all five patients without initiation of other tachyarrhythmias. Autodecremental ventricular pacing was successful in one of the two patients in which it was used. This new modality of pacing has several theoretical advantages over conventional methods: the decremental mode may avoid stimulation in the vuJnerabie period and minimizes the risk of initiating other tachyarrhythmias: gradual acceleration of pacing over o short period results in stimulation at different phases of the tachycardia cycle length; and the operator variables D and P provide a flexible system which may be adjusted to suit a particular patient and tachycardia. The development of a fully implantable programmable system is made attractive hy the simplicity and adaptability of this technique
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.