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- W1975248982 abstract "A 79-year old man with ischemic cardiomyopathy, congestive heart failure and persistent atrial fibrillation underwent DC cardioversion and insertion of a CRT-D device (Contak Renewal 3). Dofetilide 0.25 mg bid was started. Programming was DDDR 60-130 bpm. Rate-smoothing was enabled to prevent torsade de pointes. Refractory periods were left at nominal values. PVARP+ after PVC and PMT termination were enabled. The following day, the patient presented incessant runs of a paced tachycardia at the upper rate limit. AV sequential pacing with biventricular capture is followed by 2 PVCs with retrograde conduction that initiate endless loop tachycardia (ELT). The first retrograde P appropriately falls in the extended PVARP. The second one is tracked, as the device will not classify as PVCs two beats in a row. The PVCs originate in the RV. The LV activates 175 ms later. During the first beat of tachycardia, the device witholds LV pacing according to the LV protection period. The LV is thus again activated late. During ELT, there is exclusive RV capture despite delivery of a biventricular pulse, which repetitevely falls in the LV myocardial refractory period. After 16 beats, a premature P wave in PVARP terminates ELT. (PMT termination algorithm would have been activated if the VA had been constant). Rate-smoothing triggers early AV sequential stimulation. The atrial pulse fails to capture as it falls in the myocardial refractory period. (This device does not have a noncompetitive atrial pacing function). Ventricular pacing with retrograde conduction reinitiates ELT with a narrower QRS reflecting biventricular capture. ELT terminates with an early P wave 10 beats later. This time, slightly later AV pacing allows atrial capture. ELT was eliminated by extending the PVARP. After 6 months, the patient remains free of atrial fibrillation or ICD shocks. His functional class has improved." @default.
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- W1975248982 date "2005-05-01" @default.
- W1975248982 modified "2023-10-18" @default.
- W1975248982 title "Unusual manifestations of endless loop tachycardia in a cardiac resynchronization defibrillator" @default.
- W1975248982 doi "https://doi.org/10.1016/j.hrthm.2005.02.1036" @default.
- W1975248982 hasPublicationYear "2005" @default.
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