COMPARISON OF DECREMENTAL AND BURST OVERDRIVE PACING AS TREATMENT FOR VENTRICULAR-TACHYCARDIA ASSOCIATED WITH CORONARY-ARTERY DISEASE

Several forms of antitachycardia pacing have been used successfully for terminating cardiac arrhythmias, and implantable devices now incorporate a tier of overdrive pacing for treating of ventricular tachycardia (VT). No consensus exists regarding the optimal mode of pacing therapy. Accordingly, a prospective, randomized, crossover study of antitachycardia pacing was performed to analyze the effects of 2 decremental forms (10 and 5 ms) and a synchronized burst overdrive pacing mode on episodes of VT. Overdrive antitachycardia pacing was an effective therapy (78%) for terminating VT. Burst overdrive pacing and an autodecremental pacing protocol, incorporating a 10 ms decrement, were found to be effective and comparable forms of therapy. Both of these pacing methods were superior in terminating VT when compared with a pacing scheme using a 5 ms coupling decrement (p <0.01). Tachycardia acceleration occurred in 6.4% of the episodes of VT. None of the pacing methods displayed a specific propensity for tachycardia acceleration, and no measure of tachycardia segments identified a predilection for pace terminability. Antitachycardia pacing is an effective therapy for VT and different pacing formulas have variable effects. Further, these effects appear to be independent of tachycardia cycle length and variability.