High ventricular rate


  • 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


  • 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


  • 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


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