This 74-year-old man presenting with ischemic cardiomyopathy, a left ventricular ejection fraction at 45%, and syncope without prodrome, underwent implantation of an Ensura dual chamber pacemaker in the background of a prolonged PR interval and diurnal episodes of Wenckebach rhythm; an episode of ventricular tachycardia was recorded in the device memory.
Tracing 8a: graph illustrating the episode;
Tracing 8b: EGM corresponding to this episode;
This tracing highlights the challenging issue of recordings of runs of non-sustained ventricular tachycardia in pacemaker recipients. The recorded episode might call into question the initial diagnosis. The patient underwent pacemaker implantation after a syncopal episode occurring in the background of AV conduction abnormalities. The device memory revealed another potential diagnosis, i.e. rapid ventricular tachycardia in the context of ischemic cardiomyopathy.
It seems legitimate, in this patient, to proceed with programmed ventricular stimulation, and to upgrade his system to an implantable cardioverter defibrillator, if sustained ventricular tachycardia is inducible.
