A 68-year-old recipient of an EnTrust VR single chamber ICD implanted for secondary prevention after a large anterior myocardial infarction, syncope and VT, presents with recurrent syncope and perception of ICD shock.
As mentioned earlier, ATP is first line therapy for regular VT. It terminates 75% of VT episodes at rates ranging between 188 and 250 bpm, without markedly increasing the risk of syncope or VT acceleration. The programmable ATP settings are : 1) burst or ramp (ramp is more aggressive than burst), 2) the cycle length as a fixed percentage of the VT cycle length (the shorter the interval, the more aggressive the therapy), 3) the number of pulses delivered (a larger number increases the aggressiveness of the therapy, particularly in a ramp), 4) the minimal pulse interval authorized (the shorter, the more aggressive the therapy).
Episode of fast VT detected by the combined counter alternatively in the VT and FVT zones. The ventricular EGM morphology during tachycardia was significantly different from that recorded during sinus rhythm. However, this last criterion was not used in the FVT via VF or the VF zone. Note that the algorithm for “progressive therapy” was activated. A ramp was programmed for the first part of the FVT zone and ended the tachycardia.
