Hanane ZouzouUniversity Batna, Algeria
Title: The effectiveness of Anti tachycardia pacing in selected patients with implantable cardioverter defibrillator.
Background: Implantable Cardioverter Defibrillators remain cornerstone of therapy for patients at high risk for sudden cardiac death. High-energy shocks delivered have a number of adverse consequences. Anti-tachycardia pacing often neglected in the past because of concerns about its efficacy, especially in fast ventricular tachycardia, the risk of arrhythmia acceleration and the possibly of syncope due to delayed definitive shock therapy. Its efficiency depends essentially on the mechanism of ventricular arrhythmia; it could be more efficient in reentrant ventricular tachycardia; this mechanism is often encountered in arrhythmogenic right ventricular dysplasia / cardiomyopathy and ischemic cardiomyopathy.
Cases report: We report the efficiency of anti-tachycardia pacing as first and unique therapy for nineteen patients: Six patients with arrhythmogenic right ventricular dysplasia / cardiomyopathy, nine with ischemic cardiomyopathy, and four with dilated cardiomyopathy. Before implantation, sixteen patients had experienced syncope and/or hemodynamic instability and three patients had experienced cardiac arrest. All those patients were received Implantable cardioverter defibrillators: fifteen dual chambers and four with resynchronization therapy.
Results: Anti-tachycardia pacing was efficient for all those patients, they didn’t feel discomfort. In one of our patients one episode of ventricular tachycardia was accelerated into fast ventricular tachycardia by 9 bursts therapies but rapidly reverted by ramp therapy. Anti-tachycardia pacing programming was tailored depends on the mechanism of arrhythmias and also on the rate of spontaneous VT. During follow up, the low recurrence of ventricular tachycardia has become obvious for the majority of patients, and marked improvement of left ventricular systolic function in patients with ischemic cardiomyopathy.
Conclusion: Tailored Anti-tachycardia pacing programming could be more effective and safe in patients with implantable cardioverter defibrillator; it may contribute to the improvement of left ventricular function and the reduction of ventricular tachycardia recurrence.
Class "A" Lecturer in Cardiology, Department of Medicine, Algeria