A 68-year old male patient with a history of ischemic cardiomyopathy and left bundle branch block for which he was implanted with a triple-chamber Boston Scientific Incepta CRT-D was hospitalized for cardiac decompensation. Interrogation of the device revealed multiple episodes of VT.
This patient was hospitalized due to severe cardiac decompensation in the context of palpitations and electrical storm. The surface electrocardiogram revealed multiple episodes of VT, some terminated spontaneously with fluctuating durations while others were terminated by ATP. Various mechanisms may explain why these episodes of VT exacerbated cardiac decompensation: loss of biventricular stimulation, tachycardia, atrio-ventricular dissociation, … There was no obvious trigger (ischemia, hypokaliemia) to explain this episode of electrical storm. Modifying the lower limit of the VT permits the device to more readily treat these types of episode by anti-tachycardia pacing.
