Antitachycardia pacing during effective refractory period a hypothesis of an underlying mechanism

Optimizing Antitachycardia Pacing

Implantable cardioverter-defibrillators (ICDs) substantially reduce sudden cardiac death. Paradoxically, even though ICDs are implanted to prevent sudden cardiac death by delivering therapies, appropriate and inappropriate ICD shocks have been associated with an increased risk of mortality.1 However, patients treated with ICD shocks show even poorer survival than patients treated with antitachy...

Structural Heterogeneity Modulates Effective Refractory Period: A Mechanism of Focal Arrhythmia Initiation

Reductions in electrotonic loading around regions of structural and electrophysiological heterogeneity may facilitate capture of focal triggered activity, initiating reentrant arrhythmias. How electrotonic loading, refractoriness and capture of focal ectopics depend upon the intricate nature of physiological structural anatomy, as well as pathological tissue remodelling, however, is not well un...

Antitachycardia pacing programming in implantable cardioverter defibrillator: A systematic review

Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regard...

Implantable Cardioverter Defibrillator Shock Despite Termination of Ventricular Tachycardia by Antitachycardia Pacing During Charging

Dual chamber pacing mode in an atrial antitachycardia pacing device without a ventricular lead - A necessary evil.

We present a case of a single chamber atrial pacemaker implanted for sinus node dysfunction and treatment of macroreentrant atrial tachycardias with atrial antitachycardia pacing. The patient presented with sustained atrial tachycardia above the detection rate, however, the device was unable to detect the tachycardia and did not deliver the programmed therapy. We discuss the nuances of the atri...