VT acceleration by antitachycardia pacing followed by electrical shock

Patient

84-year-old man presenting with ischemic cardiomyopathy underwent implantation of a Boston Science Teligen dual chamber defibrillator for secondary prevention of VT. He suffered from chronic AFib and abnormal atrioventricular conduction. He was seen for a complaint of palpitation followed by near syncope and delivery of an electrical shock.

Summary

Tachycardia detected initially in the VT zone and requiring a salvo of ATP; secondary acceleration of the VT diagnosed in the VF zone, followed by delivery of a 41-J shock.

Trace

Graph and tracing

probable atrial tachycardia and rate responsive ventricular pacing;
sudden onset of a monomorphic and regular tachycardia;
VT diagnosed by the device;
first therapy in the VT zone: burst of 8 cycles with probable ventricular capture;
acceleration of the VT to the VF zone with change in the morphology of the ventricular electrograms;
diagnosis of VF and charge of the capacitors;
end of the charge;
delivery of 41-J shock;
termination of atrial and ventricular arrhythmias.

Pacing & Defibrillation

ECG

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