Initial defibrillation energy programming is based on the defibrillation threshold. 4 Ventricular fibrillation produces syncope in many patients and requires a highly effective shock. For cardioversion of fast ventricular tachycardia, a 5-joule biphasic waveform shock can achieve approximately 80% success. 5 The second zone is often associated with significant symptoms, but early cardioversion with a rapid change time and a lower energy shock may abort syncope. Antitachycardia pacing is most effective in termination of monomorphic ventricular tachycardia, especially with rates below 180 bpm, and has efficacy rates of >80%. The slowest zone is usually associated with nonsyncopal rhythms, and these are often responsive to antitachycardia pacing. 4 Such discrimination is useful for clinical and therapeutic purposes. When empirical programming is sought in patients with VT or cardiac arrest, we prefer to establish three zones for “slow” ventricular tachycardia, “fast” monomorphic ventricular tachyarrhythmias, and ventricular fibrillation. In some instances, when prophylaxis from ventricular fibrillation alone is needed, as in patients with long QT syndrome, a single zone may suffice. In general, a minimum of two-zone programming is usually performed for discrimination of a monomorphic ventricular tachycardia from ventricular fibrillation. Ventricular rhythm detection in these systems is based on ventricular electrogram rate, regularity, morphology, and patterns of electrogram interval changes. In its simplest iteration, the ICD device is capable of detecting and treating ventricular tachyarrhythmias and permitting ventricular pacing and monitoring of ventricular rhythm. Single Chamber Ventricular ICD Technology D, Arrhythmia logbook showing episodes of ventricular fibrillation with time-date stamp and access to stored electrograms in a dual chamber ICD. C, Programmer screen shows measured data on atrial and ventricular lead function in dual chamber ICD. Ventricular defibrillation is performed with a 541 V leading edge voltage shock that terminates both rhythms. Both rapid rhythms are detected and correctly diagnosed with AV dissociation. A DC current is applied during sinus rhythm and initiates both atrial and ventricular fibrillation. P and R markers are annotations of the two electrograms and intervals are shown in ms. The top trace shows atrial electrograms, the middle trace shows current application, and the lower trace shows ventricular electrograms. B, Noninvasive electrophysiological stimulation to evaluate ventricular defibrillation efficacy in a dual chamber ICD. An additional coronary sinus pacing lead is placed outside the ostium for dual site right atrial pacing. Note the distinct atrial and ventricular pacing and defibrillation leads. A, Lateral radiograph of the chest showing the first dual chamber atrioventricular defibrillator inserted in patient with refractory atrial fibrillation.
Refractory atrial flutter icd 10 Activator#
The patient was given a handheld activator for termination of atrial fibrillation (AF) and flutter.įigure 1.
An additional coronary sinus lead was placed to permit dual site right atrial pacing for prevention of atrial flutter and fibrillation ( Figure 1A). The following day, a dual chamber ICD capable of defibrillation and antitachycardia, as well as standard demand pacing in both chambers, was inserted. A linear ablation of the tricuspid valve-inferior vena cava isthmus interrupted common flutter, but atypical flutter persisted. Electrophysiological evaluation revealed isthmus- (common or typical) and nonisthmus- (atypical) dependent atrial flutter and inducible hypotensive monomorphic sustained ventricular tachycardia. He had been treated with anticoagulation and antiarrhythmic drugs, but it was noted on admission that he was in atrial flutter with a ventricular rate of 110 bpm. He had a past history of dilated cardiomyopathy, old cerebrovascular accident, symptomatic atrial flutter/fibrillation, and heart failure. Customer Service and Ordering InformationĪ 75-year-old man presented with near-syncope and ventricular arrhythmias.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).
0 kommentar(er)
