Chapter 1 · Counters · Case 14

VT and the monitor zone

Patient and episode

Patient

  • Male implanted with a single-chamber defibrillator (Evera XT VR) for primary prevention of severe dilated cardiomyopathy.

The recording

Tap a number on the trace, or an entry in the list below

Rate / interval plot

Medtronic ICD electrogram, segment 1 of 1 — VT and the monitor zone

EGM

Medtronic ICD electrogram, segment 1 of 2 — VT and the monitor zone
Medtronic ICD electrogram, segment 2 of 2 — VT and the monitor zone
  1. What diagnosis is suggested by the interval plot? The episode was classified as VT-Mon by the device (1); the plot shows a regular tachycardia in the monitor zone, terminating spontaneously after more than 7 minutes (2).
  2. What is your diagnosis? The EGM showed probable VT in the monitor zone (cycles classified as VS) with spontaneous reversion.

Points to remember

  • This trace shows a VT episode recorded in the monitor zone; in a monitor zone, no therapy is programmed.
  • Latest international recommendations favour programming a single VF zone for primary prevention with rates > 188 bpm; the aim is to avoid inappropriate therapies and focus on treatment of the most serious, life-threatening arrhythmias.
  • It may also be useful to programme a monitor zone to check for the occurence of slower arrhythmias that may warrant treatment.

Practice out loud

Just describe the tracing. What do you think is going on? Describing the numbers can help.

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From Medtronic ICD — clinical cases by P. Bordachar, A. Thiyagarajah, L. Fontagne, M. Strik, S. Ploux. Published by Cardiocases. Every numbered marker on a recording is explained in the list beneath it; tap a marker on the trace or an entry in the list.

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