Philippe Ritter

Ischemic cardiomyopathyFollow-upvisit

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Philippe Ritter, MDCHU de Bordeaux

Hôpital Haut Lévêque

Cardiostim Chairman

Philippe Ritter

Ischemic cardiomyopathyFollow-upvisit

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Battery OK

Leads OK

1 VT/VF treated

Philippe Ritter

Programmable parameters

Philippe Ritter

Fast atrial rate

Slow ventricular rate

VT or VF

ATP

No effect,VT or VF

2nd ATP

VT Termination

But shock !

Atrial TachycardiaterminationEpisode end

Philippe Ritter

Atrial tachyarrhythmia

Slow ventricular rate V acceleration

Bi-tachycardiadetected

ATP

Philippe Ritter

Failure of 1st ATP

VF diagnosed

Charge stillgoing

VT stopped

Charge end

Philippe Ritter

Short VV cycles after charge

Sinus rhythmresumes

But inappropriateshock

In VF zone, Charge does not stop after ATP delivery.When ATP duringchargingisprogrammed, and if 2 short VV cycles occur

after Charge End (CE) beforedetection of slow rhythm, Charge is Delivered (CD)

If ATP were programmed in the VF zone before charge, the system would have not shocked.

There would have been redectection after ATP; Sinus rhythmwould have been diagnosed, and no shockwould have occurred.However, if VF would not have been terminated by ATP,

shockdeliverywould have been delayed !