Patient
- 59-year-old man
- AccentTM DR pacemaker (Abbott) for obstructive hypertrophic cardiomyopathy
- episode of syncope
- high ventricular rate episode corresponding to the time of syncope
Tracing
- atrial sensing and ventricular pacing
- VT episode with atrioventricular dissociation
- acceleration of the VT rate which becomes very rapid (240 bpm) thus explaining the syncope
Comments
- recording episodes of non-supported ventricular tachycardia in pacemaker-implanted patients is relatively common
- management varies depending on the presence of symptoms and the presence of heart disease which may justify the decision to upgrade to an implantable ICD
- in this patient with hypertrophic cardiomyopathy and syncopal VT episode, ICD indication is warranted