[Ventricular arrhythmias induced by appropriate antibradycardia pacing in patients with implantable defibrillators].
OBJECTIVE
The induction of ventricular arrhythmias by appropriate antibradycardia ventricular pacing in patients with implantable cardioverter defibrillators has been reported in only a few cases. The aim of this study was to assess the incidence, characteristics and management of these episodes.


METHODS
The follow-up records of 180 patients with implantable cardioverter defibrillators with intracardiac electrogram storage were reviewed. Pacing induced episodes were defined as those occurring immediately after an appropriate paced stimulus in a patient with sporadic paced beats. We assessed the number and type of episodes, mode of onset, therapy administered and the efficacy of different prevention measures.


RESULTS
Pacing induced episodes were found in 9 patients (5%). Seven received device administered therapy which was effective in all cases. One to 95 episodes were observed per patient, of which 138 were monomorphic ventricular tachycardias and 20 polymorphic ventricular tachycardia/ventricular fibrillation episodes. All were induced by a paced ventricular beat after a post-extrasystolic pause or after long RR intervals during atrial fibrillation. Pacing induced arrhythmias were prevented by changing the pacing rate or hysteresis in 3 out of 6 patients and by decreasing the stimulus energy in 3 out of 3. Antibradycardia pacing function was disabled in 4 patients.


CONCLUSIONS
Ventricular arrhythmias induced by appropriate antibradycardia ventricular pacing are relatively common in patients with implantable cardioverter defibrillators. Effective prevention can be achieved in most cases by changing the pacing rate or the pacing stimulus energy, however in selected cases the antibradycardia function may be disabled.
Martínez Sánchez
J
J
Servicios de Cardiología. Hospital Universitario Virgen de la Arrixaca. Murcia.
García Alberol
A
A
Almendral Garrote
J
J
Castellanos
E
E
Pérez Castellanos
N
N
Ortiz Patón
M
M
Sánchez Muñoz
J J
JJ
Llamas Lázaro
C
C
Ruipérez Abizanda
J A
JA
Valdés Chávarri
M
M
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology*; D001919:Bradycardia / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006352:Heart Ventricles; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies