Implantable Cardioverter Defibrillator Proarrhythmia Due to an Interaction with “Noncompetitive Atrial Pacing”: An Algorithm to Prevent Atrial Arrhythmias

Cron, Thomas A.; Schaer, Beat; Oßwald, Stefan

doi:10.1046/j.1460-9592.2002.01656.x

Cited by 6 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proposed mechanisms for pacing-induced VT/VF induction by the ICDs are short-long-short (S-L-S) sequences that are either pacing facilitated or pacing permitted, 57 atrial preference pacing, 58 and noncompetitive atrial pacing mode. 59 When the paced QRS morphology and VT morphology are similar, one should consider mechanical irritation from the lead as a potential mechanism of VT. 60 Studies aimed at reducing S-L-S sequences by using rate-smoothing algorithms have not shown consistent benefit. [61][62][63] Occasionally, pacing-facilitated S-L-S VT can be due to Wenckebach upper rate response, which see ϩ1).…”

Section: Icd Proarrhythmiamentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

show abstract

Section: Icd Proarrhythmiamentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…Although typical examples of ICD proarrhythmia are acceleration of VT by antitachycardia pacing or cardioversion and induction of new ventricular tachyarrhythmias due to inappropriate ICD therapy, 2 there are also cases of ventricular arrhythmia induction by antibradycardia pacing in normally and abnormally functioning ICDs 3,6 . Cron et al 3 reported a case of ICD (Medtronic GEM III AT 7276; Medtronic Inc., Minneapolis, MN, USA) proarrhythmia in which an intermittent atrial far‐field R‐wave sensing caused inappropriate mode switching to the DDIR mode. Simultaneously, the “noncompetitive atrial pacing” algorithm delayed a scheduled atrial paced event, causing the coincidence of atrial pacing and intrinsic R wave.…”

Section: Discussion and Clinical Implicationsmentioning

confidence: 99%

“…Although the efficacy of implantable cardioverter‐defibrillator (ICD) therapy for ventricular arrhythmias is well established, 1 it is also well known that they can provoke new arrhythmias 2 . New ICD algorithms to treat and/or prevent tachyarrhythmias could be associated with a higher risk of device proarrhythmia 3 . This report describes an episode of device‐induced ventricular tachycardia (VT) related to the activation of the “atrial preference pacing” (APP), an algorithm to prevent atrial tachyarrhythmias.…”

Section: Introductionmentioning

confidence: 99%

ICD Proarrhythmia as a Consequence of an Interaction with an Algorithm to Prevent Atrial Arrhythmias

Martínez‐Sánchez

García‐Alberola

Sánchez-Muñoz

et al. 2009

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Conversely, a patient with a retrograde accessory pathway had improvement of NRVAS by turning on NCAP 2 . NCAP has also been associated with ventricular tachycardia in a patient in the setting of atrial lead far‐field oversensing and a ventricular sensed event occurring in the atrial blanking period 3 …”

Section: Commentarymentioning

confidence: 99%

Alternating Pacemaker AV Delays: The Long and Short of It

Prutkin

Mitchell

2012

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Implantable Cardioverter Defibrillator Proarrhythmia Due to an Interaction with “Noncompetitive Atrial Pacing”: An Algorithm to Prevent Atrial Arrhythmias

Cited by 6 publications

References 8 publications

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

ICD Proarrhythmia as a Consequence of an Interaction with an Algorithm to Prevent Atrial Arrhythmias

Alternating Pacemaker AV Delays: The Long and Short of It

Contact Info

Product

Resources

About