Incidence and mechanism of interruption of reentrant ventricular tachycardia with rapid ventricular pacing.

Aizawa, Yoshifusa; Niwano, Shinichi; Chinushi, Masaomi; Tamura, Makoto; Kusano, Yoriko; Miyajima, Toshiro; Kitazawa, Hitoshi; Shibata, Akira

doi:10.1161/01.cir.85.2.589

Cited by 86 publications

(34 citation statements)

References 26 publications

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“…The ventricular tachycardias were not induced by programmed electrical stimulation. 26) Of these, 2 de novo mutations were confirmed in 3 patients from 2 families as reported elsewhere. 15,16) ECG findings: The ECGs of 7 patients had normal PR and QT intervals as well as QRS complexes but they showed a relatively slow heart rate (43-60 beats/ min.)…”

Section: Methodsmentioning

confidence: 66%

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

et al. 2006

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SUMMARYAlthough catecholaminergic polymorphic ventricular tachycardia (CPVT) is associated with fatal ventricular arrhythmias and sudden death, the ECG findings are not fully understood. In this paper, we report on alterations in the U-wave.Seven patients from 6 families with CPVT in which bidirectional tachycardia and polymorphic VT were induced by exercise or isoproterenol infusion visited our hospitals. VT was not inducible by programmed electrical stimulation. A novel gene mutation of the ryanodine receptor 2 (RyR2) was confirmed in 2 families.In one of these patients, U-wave alternans was observed following ventricular pacing at 160 beats/min. In the other patient, U-wave alternans was observed during the recovery phase after the exercise stress test, which was terminated because of polymorphic VT. In both cases, leads V 3 -V 5 were the leads showing alternans most clearly. In the third patient, a negative U-wave became positive following a pause from sinus arrest and a change in T-wave was also noted.Since such findings were not found in the other subjects who underwent electrophysiologic study, isoproterenol infusion or exercise stress testing, the phenomenon seems to be relevant to the underlying pathogenesis of CPVT. The genesis and significance of Uwave alteration need to be determined. (Int Heart J 2006; 47: 381-389)

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Section: Methodsmentioning

confidence: 66%

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

et al. 2006

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“…7 Although only nonsustained polymorphic ventricular tachycardia was induced by programmed stimulation, the patient was considered a candidate for ICD therapy because VF had been clinically documented. In March 1999, the same model transvenous ICD system was implanted and 30 J was set as the initial treatment of VF.…”

Section: Casementioning

confidence: 99%

“…After obtaining written informed consent, an electrophysiological study (EP) was performed using the standard technique. 7 Although only non-sustained VT were induced by programmed stimulation, ICD therapy was indicated because VF had been documented clinically.…”

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confidence: 99%

Inappropriate Discharges From an Intravenous Implantable Cardioverter Defibrillator Due to T-Wave Oversensing

et al. 2001

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he implantable cardioverter-defibrillator (ICD) effectively terminates ventricular tachycardia (VT) and ventricular fibrillation (VF) and can prevent sudden cardiac death. 1,2 Tachycardia is identified primarily from the measurement of heart rate and/or the morphology of an intraventricular electrogram, so ICD therapy can be prescribed for supraventricular tachycardia or other causes of increased heart rate. [3][4][5] However, for supraventricular tachycardia, a dual-chamber ICD would decrease the frequency of inappropriate shocks from the ICD. Other mechanisms of inappropriate discharge of the ICD include non-sustained VT, pacemaker interference or T-wave oversensing. The autogain control system of the ICD detects the small amplitude electrograms during VF, but increased sensitivity leads to increased sensing of diastolic signals, particularly T-waves. On the other hand, decreased sensitivity for T-wave might result in a failure of VF sensing. 6 Moreover, ICD discharges due to T-wave oversensing during sinus rhythm can induce ventricular tachyarrhythmias. Thus, T-wave oversensing is an important problem for patients with an ICD. We report 2 cases of inappropriate shocks caused by T-wave oversensing in ICDs. Case Reports Case 1A 65-year-old female was referred for further treatment of cardiac arrest caused by VF. She had been diagnosed as Japanese Circulation Journal Vol.65, July 2001 having cardiac sarcoidosis and a daily 50-mg oral administration of prednisolone (PSL) had been started in another hospital. However, VF developed during tapering of the PSL dosage.When she was subsequently admitted to hospital, her chest X-ray showed mild cardiomegaly and bilateral hilar lymphadenopathy, but no pulmonary congestion. The 12-lead ECG during sinus rhythm showed complete right bundle branch block. Two-dimensional echocardiography revealed no abnormality of left ventricular wall motion or chamber size, and 99m Tc-pyrophosphate revealed no abnormal uptake. After obtaining written informed consent, an electrophysiological study (EP) was performed using the standard technique. 7 Although only non-sustained VT were induced by programmed stimulation, ICD therapy was indicated because VF had been documented clinically.In April 1998, a transvenous ICD system (Medtronic Micro Jewel II, 7223Cx, model 6943 right ventricular screw-in lead, Minneapolis, MN, USA) was implanted. At operation, shocks of 20 J were twice confirmed to be capable of terminating VF induced by T-wave shock, and 30 J was set as the initial treatment of VF. The amplitude of the ventricular electrogram from the tips of the defibrillation lead was 7.5 mV during sinus rhythm and the pacing threshold at the site was 2.0 V at a pulse width of 0.10 ms. One month later, the patient experienced 4 discrete inappropriate shocks during sinus rhythm of 94 beats/min. The stored electrograms showed decreased R-wave amplitude (2.1 mV) and increased T-wave amplitude (2.3mV). Both R-and T-waves were detected at the ventricular sensing threshold of 0.3 mV and this led to...

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“…22, 25 SVT is treated mainly with procaineamide and lidocaine. 26, 27 Amiodarone and nifekalant are recommended for patients with refractory SVT.…”

Section: Sustained Ventricular Tachycardiamentioning

confidence: 99%

Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version -

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Incidence and mechanism of interruption of reentrant ventricular tachycardia with rapid ventricular pacing.

Abstract: Based on our observations in these patients, ventricular tachycardia interruption is very often associated with orthodromic block in the reentrant circuit at a critical cycle length of rapid pacing.

Cited by 86 publications

References 26 publications

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

Inappropriate Discharges From an Intravenous Implantable Cardioverter Defibrillator Due to T-Wave Oversensing

Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version -

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