Extracorporeal Automatic Anti-Tachycardia Pacing and Defibrillation for Incessant Ventricular Tachycardia Using a Donated Implantable Cardioverter-Defibrillator

Background: We describe the extracorporeal use of an implantable cardioverter-defibrillator for treatment of post-operative incessant ventricular tachycardia prior to permanent implantable cardioverter-defibrillator implantation and subsequent catheter ablation. Methods & Results: A 54 year-old male, 3 days post aorto-coronary bypass developed hemodynamically unstable, monomorphic fast ventricular tachycardia. Multiple anti-arrhythmics and transcutaneous defibrillations failed to control the rhythm. A pacing/defibrillation lead was inserted and connected extra-corporeally to a donated implantable cardioverter-defibrillator that was programmed at the bedside. 198 episodes of ventricular tachycardia occurred over a 3-day period. Anti-tachycardia pacing sequences terminated 194 episodes (98%). Anti-tachycardia pacing sequences caused ventricular fibrillation in 4 cases. Conclusion: Automatic anti-tachycardia pacing deserves further study in the acute setting.

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