Rate smoothing with cardiac pacing for preventing torsade de pointes

Cardiac pacing remains one of the most effective means for preventing torsa de de pointes in patients with long QT syndrome (LQTS), However, fatal arrh ythmias may occur despite combined therapy with beta blockers and pacing, a nd it is possible that failure of cardiac pacing for preventing arrhythmias in the long run is related (at least in part) to suboptimal pacemaker prog ramming, Preventing sudden pauses may be especially important for preventin g arrhythmias in the LQTS because such peruses are highly proarrhythmic in this patient population. Unfortunately, properly functioning pacemakers can not be expected to prevent postextrasystolic pauses. The use of a pause-pre vention pacing algorithm-rate smoothing-for preventing pause-dependent tors ade de pointes is described in 12 patients with cardiac arrest or syncope d ue to congenital LQTS who were followed for 21 +/- 11 months. (C) 2000 by E xcerpta Medica, Inc.