A Reveal XT was implanted for monitoring of atrial arrhythmias.

Tracing

N° 12

Manufacturer Medtronic Device ILR Field Reveal DX / Reveal XT

Patient

Graph and trace

Automatically recorded episode.

sinus rhythm;
acceleration of heart rate and development of regular narrow QRS tachycardia, most likely common atrial flutter or atrial tachycardia; however, the device diagnosed VT based on a) the heart rate >120 bpm (above the programmed lower VT limit of 120 bpm), b) the stability of the rhythm (programmed at 40 ms), and c) the sudden onset (programmed at 81%);
evolution to AF; the graph shows a dispersion of data points, confirmed by the instability of the R-R interval on the ECG;
diagnosis of AF after 2 minutes of arrhythmia.

Comments

This report offers a global description of the arrhythmic burden, which may have important therapeutic consequences. The duration of the episodes must be included when pondering whether to introduce an antithrombotic regimen while the shortest duration justifying its introduction is ill-defined. The time of onset of the episodes may also influence the decision to introduce an antiarrhythmic regimen. Should the episodes systematically occur at night, a vagal mechanism is suspected and beta-adrenergic blockade avoided. Conversely, beta-adrenergic blockade should be strongly considered if the episodes develop systematically during exercise. Furthermore, the ventricular rate following an arrhythmic episode helps modulating a rate-slowing treatment.

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