Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1993 Jul;70(1):61–69. doi: 10.1136/hrt.70.1.61

Efficacy of a tiered therapy defibrillator system used to treat recurrent ventricular arrhythmias refractory to drugs.

A C Rankin 1, S Zaim 1, A Powell 1, B Zaim 1, R Brooks 1, B A McGovern 1, H Garan 1, J N Ruskin 1
PMCID: PMC1025230  PMID: 8038001

Abstract

OBJECTIVE--To evaluate an implantable tiered therapy defibrillator system that delivered antitachycardia pacing treatment for slower well tolerated ventricular tachycardias and cardioversion or defibrillation for fast tachycardias or ventricular fibrillation. METHODS--A tiered treatment device (Ventritex Cadence V-100) was implanted in 30 patients with ventricular tachycardia that was refractory to drugs. Efficacy was evaluated by the responses of induced or spontaneous arrhythmias to the treatments delivered. RESULTS--Antitachycardia pacing successfully terminated 80% of episodes of ventricular tachycardia induced by non-invasive programmed stimulation, but acceleration was brought about by pacing in six patients in 10% of episodes. During a follow up of two to 17 (mean seven) months, 18 patients (60%) had recurrence of ventricular arrhythmias. Antitachycardia pacing terminated ventricular tachycardia in 17 of 18 patients in 87% of episodes. Twelve patients received shocks for ventricular tachycardia or fibrillation. Failure of pacing, with subsequent cardioversion, occurred in nine patients (50%) in one or more episodes. Acceleration of tachycardia by pacing occurred in 10 patients in 5% of episodes. Only two of these patients had experienced acceleration of previously induced arrhythmia. Five patients had spontaneous fast ventricular tachycardia or fibrillation treated by cardioversion or defibrillation. Spurious treatment was delivered in nine patients (30%), during atrial fibrillation in five, sinus tachycardia in two, and because of fracture of the sensing lead system in two patients. The retrieval of stored intracardiac electrograms was of clinical value in assessing spurious treatment. CONCLUSIONS--Tiered treatment was effective in terminating recurrent ventricular arrhythmias in these selected patients. Most episodes were treated successfully by pacing, and resistant tachycardias, pacing induced acceleration, or haemodynamically compromising arrhythmias were treated by shocks.

Full text

PDF
61

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almendral J. M., Rosenthal M. E., Stamato N. J., Marchlinski F. E., Buxton A. E., Frame L. H., Miller J. M., Josephson M. E. Analysis of the resetting phenomenon in sustained uniform ventricular tachycardia: incidence and relation to termination. J Am Coll Cardiol. 1986 Aug;8(2):294–300. doi: 10.1016/s0735-1097(86)80043-2. [DOI] [PubMed] [Google Scholar]
  2. Epstein A. E., Kay G. N., Plumb V. J., Shepard R. B., Kirklin J. K. Combined automatic implantable cardioverter-defibrillator and pacemaker systems: implantation techniques and follow-up. J Am Coll Cardiol. 1989 Jan;13(1):121–131. doi: 10.1016/0735-1097(89)90559-7. [DOI] [PubMed] [Google Scholar]
  3. Fisher J. D., Johnston D. R., Furman S., Mercando A. D., Kim S. G. Long-term efficacy of antitachycardia pacing for supraventricular and ventricular tachycardias. Am J Cardiol. 1987 Dec 1;60(16):1311–1316. doi: 10.1016/0002-9149(87)90613-8. [DOI] [PubMed] [Google Scholar]
  4. Fisher J. D., Johnston D. R., Kim S. G., Furman S., Mercando A. M. Implantable pacers for tachycardia termination: stimulation techniques and long-term efficacy. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1325–1333. doi: 10.1111/j.1540-8159.1986.tb06718.x. [DOI] [PubMed] [Google Scholar]
  5. Fisher J. D., Kim S. G., Furman S., Matos J. A. Role of implantable pacemakers in control of recurrent ventricular tachycardia. Am J Cardiol. 1982 Jan;49(1):194–206. doi: 10.1016/0002-9149(82)90294-6. [DOI] [PubMed] [Google Scholar]
  6. Fisher J. D., Kim S. G., Matos J. A., Ostrow E. Comparative effectiveness of pacing techniques for termination of well-tolerated sustained ventricular tachycardia. Pacing Clin Electrophysiol. 1983 Sep;6(5 Pt 1):915–922. doi: 10.1111/j.1540-8159.1983.tb04413.x. [DOI] [PubMed] [Google Scholar]
  7. Fisher J. D., Mehra R., Furman S. Termination of ventricular tachycardia with bursts of rapid ventricular pacing. Am J Cardiol. 1978 Jan;41(1):94–102. doi: 10.1016/0002-9149(78)90138-8. [DOI] [PubMed] [Google Scholar]
  8. Fogoros R. N., Elson J. J., Bonnet C. A. Actuarial incidence and pattern of occurrence of shocks following implantation of the automatic implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 1989 Sep;12(9):1465–1473. doi: 10.1111/j.1540-8159.1989.tb06151.x. [DOI] [PubMed] [Google Scholar]
  9. Gabry M. D., Brodman R., Johnston D., Frame R., Kim S. G., Waspe L. E., Fisher J. D., Furman S. Automatic implantable cardioverter-defibrillator: patient survival, battery longevity and shock delivery analysis. J Am Coll Cardiol. 1987 Jun;9(6):1349–1356. doi: 10.1016/s0735-1097(87)80477-1. [DOI] [PubMed] [Google Scholar]
  10. Gottlieb C. D., Rosenthal M. E., Stamato N. J., Frame L. H., Lesh M. D., Miller J. M., Josephson M. E. A quantitative evaluation of refractoriness within a reentrant circuit during ventricular tachycardia. Relation to termination. Circulation. 1990 Oct;82(4):1289–1295. doi: 10.1161/01.cir.82.4.1289. [DOI] [PubMed] [Google Scholar]
  11. Greve H., Koch T., Gülker H., Heuer H. Termination of malignant ventricular tachycardias by use of an automatical defibrillator (AICD) in combination with an antitachycardial pacemaker. Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):2040–2044. doi: 10.1111/j.1540-8159.1988.tb06347.x. [DOI] [PubMed] [Google Scholar]
  12. Holley L. K., Cooper M., Uther J. B., Ross D. A. Safety and efficacy of pacing for ventricular tachycardia. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1316–1319. doi: 10.1111/j.1540-8159.1986.tb06716.x. [DOI] [PubMed] [Google Scholar]
  13. Hook B. G., Marchlinski F. E. Value of ventricular electrogram recordings in the diagnosis of arrhythmias precipitating electrical device shock therapy. J Am Coll Cardiol. 1991 Mar 15;17(4):985–990. doi: 10.1016/0735-1097(91)90884-c. [DOI] [PubMed] [Google Scholar]
  14. Kadish A. H., Buxton A. E., Waxman H. L., Flores B., Josephson M. E., Marchlinski F. E. Usefulness of electrophysiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy. J Am Coll Cardiol. 1987 Jul;10(1):90–96. doi: 10.1016/s0735-1097(87)80165-1. [DOI] [PubMed] [Google Scholar]
  15. Kelly P. A., Cannom D. S., Garan H., Mirabal G. S., Harthorne J. W., Hurvitz R. J., Vlahakes G. J., Jacobs M. L., Ilvento J. P., Buckley M. J. The automatic implantable cardioverter-defibrillator: efficacy, complications and survival in patients with malignant ventricular arrhythmias. J Am Coll Cardiol. 1988 Jun;11(6):1278–1286. doi: 10.1016/0735-1097(88)90292-6. [DOI] [PubMed] [Google Scholar]
  16. Keren G., Miura D. S., Somberg J. C. Pacing termination of ventricular tachycardia: influence of antiarrhythmic-slowed ectopic rate. Am Heart J. 1984 Apr;107(4):638–643. doi: 10.1016/0002-8703(84)90308-9. [DOI] [PubMed] [Google Scholar]
  17. Leitch J. W., Gillis A. M., Wyse D. G., Yee R., Klein G. J., Guiraudon G., Sheldon R. S., Duff H. J., Kieser T. M., Mitchell L. B. Reduction in defibrillator shocks with an implantable device combining antitachycardia pacing and shock therapy. J Am Coll Cardiol. 1991 Jul;18(1):145–151. doi: 10.1016/s0735-1097(10)80232-3. [DOI] [PubMed] [Google Scholar]
  18. Manolis A. S., Tan-DeGuzman W., Lee M. A., Rastegar H., Haffajee C. I., Huang S. K., Estes N. A., 3rd Clinical experience in seventy-seven patients with the automatic implantable cardioverter defibrillator. Am Heart J. 1989 Sep;118(3):445–450. doi: 10.1016/0002-8703(89)90256-1. [DOI] [PubMed] [Google Scholar]
  19. Manz M., Gerckens U., Funke H. D., Kirchhoff P. G., Lüderitz B. Combination of antitachycardia pacemaker and automatic implantable cardioverter/defibrillator for ventricular tachycardia. Pacing Clin Electrophysiol. 1986 Sep;9(5):676–684. doi: 10.1111/j.1540-8159.1986.tb05415.x. [DOI] [PubMed] [Google Scholar]
  20. Mason J. W., Winkle R. A. Electrode-catheter arrhythmia induction in the selection and assessment of antiarrhythmic drug therapy for recurrent ventricular tachycardia. Circulation. 1978 Dec;58(6):971–985. doi: 10.1161/01.cir.58.6.971. [DOI] [PubMed] [Google Scholar]
  21. Naccarelli G. V., Zipes D. P., Rahilly G. T., Heger J. J., Prystowsky E. N. Influence of tachycardia cycle length and antiarrhythmic drugs on pacing termination and acceleration of ventricular tachycardia. Am Heart J. 1983 Jan;105(1):1–5. doi: 10.1016/0002-8703(83)90269-7. [DOI] [PubMed] [Google Scholar]
  22. Newman D. M., Lee M. A., Herre J. M., Langberg J. J., Scheinman M. M., Griffin J. C. Permanent antitachycardia pacemaker therapy for ventricular tachycardia. Pacing Clin Electrophysiol. 1989 Aug;12(8):1387–1395. doi: 10.1111/j.1540-8159.1989.tb05053.x. [DOI] [PubMed] [Google Scholar]
  23. Roy D., Waxman H. L., Buxton A. E., Marchlinski F. E., Cain M. E., Gardner M. J., Josephson M. E. Termination of ventricular tachycardia: role of tachycardia cycle length. Am J Cardiol. 1982 Dec;50(6):1346–1350. doi: 10.1016/0002-9149(82)90473-8. [DOI] [PubMed] [Google Scholar]
  24. Swerdlow C. D., Winkle R. A., Mason J. W. Determinants of survival in patients with ventricular tachyarrhythmias. N Engl J Med. 1983 Jun 16;308(24):1436–1442. doi: 10.1056/NEJM198306163082402. [DOI] [PubMed] [Google Scholar]
  25. Waldecker B., Brugada P., Zehender M., Stevenson W., Den Dulk K., Wellens H. J. Importance of modes of electrical termination of ventricular tachycardia for the selection of implantable antitachycardia devices. Am J Cardiol. 1986 Jan 1;57(1):150–155. doi: 10.1016/0002-9149(86)90970-7. [DOI] [PubMed] [Google Scholar]
  26. Waldecker B., Brugada P., den Dulk K., Zehender M., Wellens H. J. Arrhythmias induced during termination of supraventricular tachycardia. Am J Cardiol. 1985 Feb 1;55(4):412–417. doi: 10.1016/0002-9149(85)90385-6. [DOI] [PubMed] [Google Scholar]
  27. Waller T. J., Kay H. R., Spielman S. R., Kutalek S. P., Greenspan A. M., Horowitz L. N. Reduction in sudden death and total mortality by antiarrhythmic therapy evaluated by electrophysiologic drug testing: criteria of efficacy in patients with sustained ventricular tachyarrhythmia. J Am Coll Cardiol. 1987 Jul;10(1):83–89. doi: 10.1016/s0735-1097(87)80164-x. [DOI] [PubMed] [Google Scholar]
  28. Waspe L. E., Kim S. G., Matos J. A., Fisher J. D. Role of a catheter lead system for transvenous countershock and pacing during electrophysiologic tests: an assessment of the usefulness of catheter shocks for terminating ventricular tachyarrhythmias. Am J Cardiol. 1983 Sep 1;52(5):477–484. doi: 10.1016/0002-9149(83)90011-5. [DOI] [PubMed] [Google Scholar]
  29. Wellens H. J., Düren D. R., Lie K. I. Observations on mechanisms of ventricular tachycardia in man. Circulation. 1976 Aug;54(2):237–244. doi: 10.1161/01.cir.54.2.237. [DOI] [PubMed] [Google Scholar]
  30. Wellens H. J., Schuilenburg R. M., Durrer D. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation. 1972 Aug;46(2):216–226. doi: 10.1161/01.cir.46.2.216. [DOI] [PubMed] [Google Scholar]
  31. Wilber D. J., Garan H., Finkelstein D., Kelly E., Newell J., McGovern B., Ruskin J. N. Out-of-hospital cardiac arrest. Use of electrophysiologic testing in the prediction of long-term outcome. N Engl J Med. 1988 Jan 7;318(1):19–24. doi: 10.1056/NEJM198801073180105. [DOI] [PubMed] [Google Scholar]
  32. Winkle R. A., Mead R. H., Ruder M. A., Gaudiani V. A., Smith N. A., Buch W. S., Schmidt P., Shipman T. Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol. 1989 May;13(6):1353–1361. doi: 10.1016/0735-1097(89)90310-0. [DOI] [PubMed] [Google Scholar]
  33. den Dulk K., Bertholet M., Brugada P., Bär F. W., Richards D., Demoulin J. C., Waleffe A., Bakels N., Lindemans F. W., Bourgeois I. A versatile pacemaker system for termination of tachycardias. Am J Cardiol. 1983 Oct 1;52(7):731–738. doi: 10.1016/0002-9149(83)90407-1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES