Matching approved 'nondedicated' hardware to obtain biventricular pacing and defibrillation: feasibility and troubleshooting.
Biventricular ICDs may offer increased bene-fit for patients with severe congestive heart failure and ventricular arrhythmia. Currently there are no approved dedicated b iventricular IGDs available. Twenty-one consecutive patients who had approved nondedicated hardware implanted for biventricular pa...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 25; no. 7; pp. 1066 - 1072 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2002
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| Acceso en línea: | Ver este registro en EBSCOhost |
| Sumario: | Biventricular ICDs may offer increased bene-fit for patients with severe congestive heart failure and ventricular arrhythmia. Currently there are no approved dedicated b iventricular IGDs available. Twenty-one consecutive patients who had approved nondedicated hardware implanted for biventricular pacing and defibrillation were included in this study. All device therapies were evaluated using stored electrograms. During mean follow-up at 13 ± 7 months, 8 (36%) patients had inappropriate shocks. Ventricular fibrillation therapy was delivered for slow ventricular tachycardia because of double counting in two patients. In one patient. AV nodal reentrant tachycardia below detection rate cut off triggered device therapy because of ventricular double counting. Sinus tachycardia or premature atrial contraction initiating A V conduction and ventricular double counting resulted in shocks in five patients. The number of shocks per patient ranged from 1 to 64. Two patients required transient disconnection of the LV lead and subsequent ICD generator replacement for premature battery depletion. Two patients required AV junction ablation and three needed slow pall: way ablation. Two patients were treated by upgrading to a device that was capable of a higher atrial tracking rate. The patients with impaired AV conduction or constant ventricular pacing did not have inappropriate therapy for sinus tachycardia or supraventricular arrhythmia. Use of conventional nondedicated hardware for biventricular pacer/defibrillator is feasible but should be considered only in patients with poor AV node function or less likely to require arititachycardic therapy, to avoid ICD double counting of ventricular sensed events and consequent high incidence of inappropriate therapies. |
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