Ventricular tachycardia electrical cardioversion: Difference between revisions
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An ICD may also be set to attempt to overdrive pace the ventricle. Pacing the ventricle at a rate faster than the underlying tachycardia can sometimes be effective in terminating the rhythm. If this fails after a short trial, the ICD will usually stop pacing, charge up and deliver a defibrillation grade shock. | An ICD may also be set to attempt to overdrive pace the ventricle. Pacing the ventricle at a rate faster than the underlying tachycardia can sometimes be effective in terminating the rhythm. If this fails after a short trial, the ICD will usually stop pacing, charge up and deliver a defibrillation grade shock. | ||
==== Recommendations for Patients With Implantable Cardioverter-Defibrillators ==== | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with implanted ICDs should receive regular follow-up and analysis of the device status. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Implanted ICDs should be programmed to obtain optimal sensitivity and specificity. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Measures should be undertaken to minimize the risk of inappropriate ICD therapies. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Patients with implanted ICDs who present with incessant VT should be hospitalized for management. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Catheter ablation can be useful for patients with implanted ICDs who experience incessant or frequently recurring VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In patients experiencing inappropriate ICD therapy, EP evaluation can be useful for diagnostic and therapeutic purposes. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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==References== | ==References== | ||
Revision as of 14:47, 30 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]
Electrical Cardioversion / Defibrillation
It is usually possible to terminate a VT episode with a direct current shock across the heart. This is ideally synchronised to the patient's heartbeat. As it is quite uncomfortable, shocks should be delivered only to an unconscious or sedated patient. A patient with pulseless VT will be unconscious and treated as an emergency on a cardiac arrest protocol. Elective cardioversion is usually performed in controlled circumstances with anaesthetic and airway support.
The shock may be delivered to the outside of the chest using an external defibrillator, or internally to the heart by an implantable cardioverter-defibrillator (ICD) if one has previously been inserted.
An ICD may also be set to attempt to overdrive pace the ventricle. Pacing the ventricle at a rate faster than the underlying tachycardia can sometimes be effective in terminating the rhythm. If this fails after a short trial, the ICD will usually stop pacing, charge up and deliver a defibrillation grade shock.
Recommendations for Patients With Implantable Cardioverter-Defibrillators
| Class I |
| "1. Patients with implanted ICDs should receive regular follow-up and analysis of the device status. (Level of Evidence: C)" |
| "2. Implanted ICDs should be programmed to obtain optimal sensitivity and specificity. (Level of Evidence: C)" |
| "3. Measures should be undertaken to minimize the risk of inappropriate ICD therapies. (Level of Evidence: C)" |
| "4. Patients with implanted ICDs who present with incessant VT should be hospitalized for management. (Level of Evidence: C)" |
| Class IIa |
| "1. Catheter ablation can be useful for patients with implanted ICDs who experience incessant or frequently recurring VT. (Level of Evidence: B)" |
| "2. In patients experiencing inappropriate ICD therapy, EP evaluation can be useful for diagnostic and therapeutic purposes. (Level of Evidence: C)" |