Patient

The patient presented to the emergency department after presyncopal lipothymia with palpitations when walking quickly to catch the tram. No shock occurred, but the patient preferred having his defibrillator analysed.

Programming

The defibrillator is of the single chamber type and two zones are programmed:

1. A VT zone from 175/min to 220/min, with 20 cycles of persistence, 3 bursts with scan, then shocks, 20 J to begin followed by maximum shocks. The 3 bursts are comprised of 8 cycles each, with a coupling interval of 80% compared to the mean cycle of the tachycardia, with a decrement of 8ms from one sequence to another (i.e. coupling interval of the VT x 80% on the first burst then, this calculated coupling minus 8 ms on all cycles of the second sequence, then another minus 8 ms on the third). The bursts therefore become increasing faster from one burst to the next, while remaining at a fixed rate during each burst. For the ramps, the first features 6 cycles with a coupling interval of 85% on the first cycle, then the following 5 cycles are each shortened by 8 ms compared to the preceding cycle in the same ramp. The ramp hence accelerates the cycle-to-cycle rate during the same sequence. One cycle is added to each ramp. In all instances, an ATP cycle cannot be shorter than 220 ms (minimum allowed coupling interval).
2. A FVT zone of 220 to 255/min with 8 cycles of persistence, and 1 burst if the rate is stable prior to the maximum shocks. The burst due to the FVT is comprised of 8 cycles with a coupling interval of 80% of the mean tachycardia cycle, with a minimum allowed cycle of 205 ms.

Summary

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