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Tachycardia Initiated by One to Two Response and Terminated by ICD Shocks

Indian Pacing and Electrophysiology Journal
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  • Case Report

Abstract 522 Case Report Tachycardia Initiated by One to Two Response and Terminated by ICD Shocks Claude S. Elayi1, Gustavo X. Morales1, Bahram Kakavand1, Jignesh S. Shah2,3 1Gill heart Institute, University of Lexington, Lexington, Kentucky 2University of Lexington, Lexington, Kentucky and 3Arrhythmia Associates, Mumbai, India Address for Correspondence: Claude S. Elayi, Gill heart Institute, University of Lexington, Lexington, Kentucky. Email: elayic/at/ Keywords: One to Two Response; ICD Shocks Case presentation A 58 year-old male was referred to our institute for recurrent palpitations followed by ICD shocks. The patient had a history of ischemic cardiomyopathy (EF 25%) and had received a dual-chamber ICD two years earlier for primary prevention of sudden cardiac death. The device interrogation showed multiple episodes of tachycardia and anti-tachycardia pacing (ATP), which frequently terminated the tachycardia. However, occasional failure to terminate the tachycardia or immediate re-initiation within the redetection window led to ICD shocks. A typical episode of tachycardia with its initiation is shown in Figure 1. Figure 1: Example of stored EGM showing initiation of tachycardia. The channels from the top to the bottom represent the atrial electrograms, the ventricular electrograms and the ICD markers. See text for description. Device interrogation showed the onset of tachycardia with a near-simultaneous atrial and ventricular activity (fourth beats). Such an onset of tachycardia with less atrial beats than ventricular beats rules out atrial tachycardia. Device interrogation also revealed multiple sequences of ATP that entrained the tachycardia with a VAV response further ruling out atrial tachycardia. The ventricular electrogram morphology during sinus rhythm was similar to that durin

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