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This patient has suffered from a VF episode which is shown at the end of the tansmission. According to the therapies summary, the episode was treated with success by a shock.
When looking at the episode, we see initial sinus rhythm with ventricular extrasystole. There is an increast in ventricular systoles with a sudden onset of a rapid ventricular arrythmia with cycles as short as 218 ms on the first strip. There are no signs of noise artifacts or of atrial arrhythmia. The VF counter is filled (blue VF marker) and the persistance counter starts. When the persistance counter is filled and the VF zone criteria are still met, the capacitors start to charge for the shock.
There is no ATP delivered as the ventricular events with a rate of around 270/min surpasses the FVT zone which is between 220 – 255 beats per minute. This is shown by the yellow marker area in the figure above. At the end of the charge a 37.6J shock is deliver which successfully terminates the arrhythmia. The first cycle following the shock is ignored and after 6 cycles slower than the slowest VT zone, the episode is terminated (blue marker Slow rhythm).
When therapies have been delivered by an ICD, we need to make sure that the ICD is in good condition. The shock impedance is within range (66 Ohms), the lead senses properly (15.4 mV), the pacing impedance is normal (455 Ohms) and the real time EGM looks good (atrial and ventricular sensing).
Most often, there are clinical consequences. The patient will be called into hospital respecting the driving restrictions imposed by national law. Cardiologist attempt to identify a possible triger for the arrhythmia such as ischemia, metabolic changes, changes in medication or co-existing disease. Often, the arrhythmia is caused by the underlying cardiac disease for which the patient was implanted with an ICD. In this case, cardiologists will evaluate the disease progression and attempt to optimize treatment. Patients with treated episodes will often be treated with anti-arrhythmia and/or ventricular ablation.
In this case, the patient was implanted because of ischemic heart disease and repeated coronoangiography revealed a new coronary lesion in the mainstem for which he was treated successfully with a stent.
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You receive the following transmission. While two arrhythmias have occured, only the VF episode is shown.
Why was there no ATP delivered in the VF episode?CorrectIncorrect