title: Ventriculoatrial conduction capability and prevalence of 1:1 retrograde conduction during inducible sustained monomorphic ventricular tachycardia in 305 implantable cardioverter defibrillator recipients.
abstract: Despite the advent of dual chamber ICDs, differentiation of VT (SMVT) with 1:1 VA conduction will remain a challenge. In this study, VA conduction capability and prevalence of inducible sustained monomorphic (SM) VT with 1:1 VA conduction was assessed in 305 ICD recipients. SMVT with a mean cycle length (CL) of 304 +/- 61 ms was induced in 161 (53%) patients. Twenty-six percent of the patients maintained 1:1 VA conduction to CL < or = 400 ms during incremental ventricular pacing, regardless of presenting tachyarrhythmia or presence of inducible SMVT. Among ten patients who had inducible SMVT with possible 1:1 VA conduction (based on SMVT CL comparable to the shortest CL associated with 1:1 retrograde conduction during ventricular pacing), all seven with available intracardiac tracings had documented 1:1 VA conduction during the induced SMVT--representing 4.4% of the patients with inducible SMVT (95% CI 1.2%-7.6%), and 2.3% of the entire ICD cohort (95% CI 0.6%-4.0%). We conclude that about one-fifth of ICD recipients possess 1:1 VA conduction to CL < or = 400 ms and that inducible SMVT with 1:1 VA conduction can be demonstrated in a small but nonnegligible proportion of ICD recipients. These data are relevant to the design of tachyarrhythmia-discrimination algorithms for dual chamber ICDs.
authors.affiliation: Arrhythmia Center, Sinai Hospital, Detroit, MI 48235, USA.
authors.forename: A
authors.initials: A
authors.lastname: Militianu
authors.forename: A
authors.initials: A
authors.lastname: Salacata
authors.forename: M D
authors.initials: MD
authors.lastname: Meissner
authors.forename: C
authors.initials: C
authors.lastname: Grill
authors.forename: R
authors.initials: R
authors.lastname: Mahmud
authors.forename: A J
authors.initials: AJ
authors.lastname: Palti
authors.forename: J
authors.initials: J
authors.lastname: Ben David
authors.forename: R
authors.initials: R
authors.lastname: Mosteller
authors.forename: T J
authors.initials: TJ
authors.lastname: Lessmeier
authors.forename: J J
authors.initials: JJ
authors.lastname: Baga
authors.forename: L A
authors.initials: LA
authors.lastname: Pires
authors.forename: C D
authors.initials: CD
authors.lastname: Schuger
authors.forename: R T
authors.initials: RT
authors.lastname: Steinman
authors.forename: M H
authors.initials: MH
authors.lastname: Lehmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*