Single capture pacemaker stimulation terminated 57% of well-tolerated sustained ventricular tachycardia episodes, compared to 94% with programmed extrastimuli or rapid pacing.
Observational (n=21)
Does single capture stimulation effectively terminate well-tolerated sustained ventricular tachycardia compared to rapid pacing?
Single capture stimulation is largely unpredictable and less effective than rapid pacing for terminating well-tolerated sustained ventricular tachycardia, limiting its long-term utility.
Absolute Event Rate: 57% vs 94%
Ventricular tachycardias can be terminated by a variety of pacemaker techniques, including rapid and slow stimulation. Fast tachycardias are typically poorly tolerated, and require prompt intervention, usually with rapid pacing. Termination of ventricular tachycardia by slow or single capture pacemaker stimulation techniques is attractive, because of its presumed safety and the possibility of using simple implantable pacers. To identify factors favoring termination, single capture stimulation was used in 390 episodes of ventricular tachycardia in 21 patients, 16 with coronary artery disease, able to tolerate ventricular tachycardia for several minutes. Single capture stimulation terminated 223 episodes (57%) in 18 patients, and two were accelerated. Of 157 episodes exposed to 2-3 programmed extrastimuli or rapid pacing 149 (94%) were terminated and 7 were accelerated. Direct current cardioversion was needed in 12 episodes. Without medications, only two patients tolerated VT. Only one patient had reliable termination with single capture stimulation over several days. Systolic blood pressure was similar in episodes terminated and not terminated by single capture stimulation, but the ventricular rate was significantly lower in episodes terminated, 116 +/- 19 vs. 1.33 +/- 24 (p less than 0.001). Termination of ventricular tachycardia was not affected by QRS morphology. Single capture termination of ventricular tachycardia is largely unpredictable, with limited reproducibility over a period of time. Although comparatively safe, single capture techniques are not likely to prove useful in the long-term treatment of many patients with recurrent ventricular tachycardia.
Fisher et al. (Fri,) conducted a observational in Well-tolerated sustained ventricular tachycardia (n=21). Single capture pacemaker stimulation vs. 2-3 programmed extrastimuli or rapid pacing was evaluated on Termination of ventricular tachycardia episodes. Single capture pacemaker stimulation terminated 57% of well-tolerated sustained ventricular tachycardia episodes, compared to 94% with programmed extrastimuli or rapid pacing.