Long-term antitachycardia pacing experience for supraventricular tachycardia.

UNLABELLED: A pacemaker was used to control drug-resistant reentrant supraventricular tachycardia (SVT) in 40 patients. An antitachycardia pacemaker was implanted in 37 for SVT; in one for ventricular tachycardia that could also be used to terminate SVT; in one SVT could be terminated with an activity rate variable pacemaker; and in one a DDD pacemaker was used for prevention and termination of SVT. Twenty patients had AV nodal reentrant tachycardias, eight had tachycardias due to a concealed accessory pathway, eight had a Wolff-Parkinson-White syndrome, three had reentrant atrial tachycardias, and one had atrial flutter. Twenty-two patients were paced from the right atrium, five from the coronary sinus, ten from the right ventricle, and three had a DDD pacemaker. During a total follow-up period of 1,503 (mean 38) months an estimated 16,240 episodes of tachycardia were terminated promptly at home, 58 required several attempts, 57 episodes lasted longer than 30 minutes but did not require medical attention, and 11 required hospital admission. Hospital admission for SVT decreased from one per patient-month (in the 3 months before implantation) to 1 per 137 patient-months after implantation. Additional reentrant tachycardias occurred in 13 patients. Antiarrhythmic drug therapy in combination with a conservative antitachycardia pacing mode was required in four patients paced from the atrium to avoid pacing induced atrial fibrillation. Antiarrhythmic drug therapy was used in 42% of patients to help control SVT.

CONCLUSIONS: (1) Drug-resistant SVTs can be safely and effectively managed on the long-term with antitachycardia pacemakers. (2) Rapid termination of SVT improved the quality-of-life significantly by avoiding prolonged episodes of tachycardia and repetitive hospital admissions.