Tachycardia Recognition by Implantable Devices
Early tachycardia interruption pacemakers relied on the recognition of tachycardia by the patient and manual activation of the device. The first generation of automatic pacemakers utilized one or more specific heart rates to trigger the tachycardia conversion response. Such systems were vulnerable to activation by sinus tachycardia resulting from physical or emotional stress. In such situations the burst or competitive pacing which resulted was particularly likely to provoke unwanted and potentially dangerous arrhythmias. Second generation anti-tachycardia pacemakers utilize other criteria to distinguish pathological from physiological tachycardia. Amongst these additional criteria the rate of change of heart rate has been most widely applied. This has reduced the likelihood of false diagnosis of pathological tachycardia but there are still many situations in which the implanted device may be activated inappropriately. The most common setting for mistaken diagnosis is immediately following a pacemaker intervention when pathological tachycardia may be “reconfirmed”when only a post tachycardia fast sinus rate is present. Of the many tachycardia recognition criteria which have been proposed cardiac activation sequence, for example AV interval during tachycardia, is the most promising technique for the accurate diagnosis of specific pathological tachycardias.
KeywordsSinus Tachycardia Reentrant Tachycardia Trigger Rate Atrial Premature Beat Atrial Stimulation
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