Implantation of a cardioverter-defibrillator in a patient with accelerated idioventricular rhythm

Kolmakov E.A., Korolev S.V.

Rationale: The most common, proven and effective method of primary and secondary prevention of SCD in patients with ventricular arrhythmias is the implantation of a cardioverter-defibrillator. However, patients with persistently recurrent ventricular arrhythmias remain at risk of frequent pulse generator defibrillation, which reduces the patient’s quality of life and increases the risk of electrical storms. The ability to achieve sustained sinus rhythm with antitachycardia pacing in patients with persistently recurrent accelerated idioventricular rhythm has not been fully studied.

Objective: To evaluate the effectiveness of treatment in a patient with a persistently recurrent idioventricular rhythm using the antitachycardia functions of an implantable cardioverter-defibrillator.

Methods: A clinical observation was made of the result of treatment of a 20-year-old patient with ineffective therapy with antiarrhythmic drugs for continuously relapsing accelerated idioventricular rhythm, arrhythmogenic cardiomyopathy, enlargement of the cavities of the left ventricle and both atria, reduced ejection fraction of the left ventricle - 49% and the right ventricle - 33%, diagnosed noncompact myocardium according to the results of MRI examination of the heart, as well as the selection of individual settings for an implantable cardioverter-defibrillator with the achievement of a stable sinus rhythm. The observation period was 3 months. Treatment outcomes were evaluated during connection to an implantable device at an outpatient appointment.

Results: During the clinical observation of the patient in the early postoperative period, there were no data for the presence of complications. During the initial setup of the cardioverter-defibrillator, the ventricular tachycardia detection zone is programmed to a rate of 90 bpm with antitachycardia pacing. 2 protocols of antitachycardia stimulation Burst and Ramp are programmed, 10 stimulation pulses in each protocol. In this zone of registration of ventricular tachycardia, the defibrillating functions of the pulse generator are disabled. To prevent hemodynamic disturbances against the background of changes in the speed characteristics of clinical tachycardia, a separate zone for recording ventricular tachycardia at 160 beats/min with the defibrillation function turned on was programmed. During a routine examination of the patient after 3 months, a subjective improvement in the patient’s well-being is recorded. According to the ultrasound examination of the heart, there is an increase in the left ventricular ejection fraction up to 64%. When collecting data from an implantable device, there is a complete absence of paroxysms of slow ventricular tachycardia.

Conclusion: In patients with slow ventricular tachycardia with ineffective antiarrhythmic therapy, the use of antitachycardia pacing with ICD for the relief of paroxysms of ventricular tachycardia is promising as a treatment choice.

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