INADEQUACY OF QUALITATIVE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ELECTROGRAM ANALYSIS TO DISTINGUISH SUPRAVENTRICULAR FROM VENTRICULAR-TACHYCARDIA DUE TO ELECTROGRAM CHANGES DURING NORMALLY CONDUCTED COMPLEXES
N. Hallett et al., INADEQUACY OF QUALITATIVE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ELECTROGRAM ANALYSIS TO DISTINGUISH SUPRAVENTRICULAR FROM VENTRICULAR-TACHYCARDIA DUE TO ELECTROGRAM CHANGES DURING NORMALLY CONDUCTED COMPLEXES, PACE, 20(6), 1997, pp. 1723-1726
Stored electrograms (EGMs) recorded from ICD leads are used to evaluat
e the appropriateness of ICD therapies. Stored EGMs different from sin
us have been interpreted as ventricular in origin. We present a patien
t with an ICD for VT who received multiple shocks for a tachycardia wi
th a stored EGM different than sin us, suggesting VT. An electrophysio
logical study demonstrated EGMs different than sinus during atrial pac
ing and induced supraventricular arrhythmias. This case points out the
limitations of stored EGMs and suggests complete electrophysiological
study with analysis of EGMs during induced arrhythmias should be perf
ormed prior to discharge.