Case 5 Assessment After Syncope

Patient: 80-year-old male with ischemic heart disease, coronary artery bypass grafting, left ventricular ejection fraction <0.35, and permanent atrial fibrillation.

Index arrhythmia: non-sustained ventricular tachycardias. Complaint: Syncope.

Electrogram (Two continuous strips are shown).

Figure 6.5a. From top to bottom: far-field ventricular electrogram, near-field ventricular electrogram, and marker channel. Markers: FD = fibrillation detected; FS = fibrillation sensing; TF: fast tachycardia sensing; TS = tachycardia sensing.

ICD pulse generator: Gem VR 7221 (Medtronic Inc, Minneapolis, MN, USA). Tachycardia settings

Detection: VF = 300 ms; fast VT via VF = 260 ms; VT = 370 ms.

Discrimination: stability = 30 ms.

Therapy: VF = shock; fast VT and VT = antitachycardia pacing and cardioversion.

Bradycardia settings

Mode: VVIR 60-120 bpm.

Electrogram interpretation

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