Sudden Cardiac Death Despite a Functional Cardioverter-Defibrillator: The Case for Early and Aggressive Therapy for Ventricular Tachycardia in Selected Patients.
We present three cases within 11 months at a single institution of sustained VT that fell below the programmed detection rate of the patients' implantable cardioverter-defibrillators (ICDs), two of which continued until converting to an agonal VF that did not meet criteria for detection, and a third case that could not be successfully defibrillated after a prolonged period of VT. These episodes may be under-recognized due to the dependence of device diagnostic storage on programming and the post-mortem effort that is often required to review these events. Some patients, likely those with the most advanced heart failure, may not tolerate sustained ventricular tachycardia (VT) and may even die from ventricular arrhythmias without ever having a rhythm that meets detection criteria in a ventricular fibrillation (VF) zone.
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.|Veterans Administration Tennessee Valley Health System, Nashville, Tennessee, USA.
Jay A
JA
Montgomery
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Arvindh N
AN
Kanagasundram
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Walter K
WK
Clair
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Jeffrey N
JN
Rottman
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
George H
GH
Crossley
D000368:Aged; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure
ICD; device programming; sudden death; ventricular fibrillation; ventricular tachycardia