Device Therapy of Ventricular Tachyarrhythmias

Device therapy is becoming increasingly important in the management of patients with life-threatening ventricular arrhythmias. Currently, antitachycardia pacemakers and endovascular cardioverters are available on an experimental basis, while the AICD is commercially available. Although the first two devices are much easier to implant, their use is limited by their potential to accelerate a tachycardia or cause it to degenerate to ventricular fibrillation, and their lack of backup high energy defibrillation capabilities. The majority of patients receiving antitachycardia devices will require concomitant antiarrhythmic therapy and all three devices have unique interactions with such drugs. Extensive evaluation and careful preimplantation patient selection are essential if device therapy is to be successful. The antitachycardia device of the future, however, will be easily implantable and much more sophisticated, combining features of all three of these devices as well as the increased flexibility provided by extensive programming and telemetry capabilities.