clinical case Ischemic cardiomyopathy

1. Ischemic cardiomyopathy Follow-upvisit « Quick Look » screen Philippe Ritter , MD CHU de Bordeaux Hôpital Haut Lévêque Cardiostim Chairman

2. Ischemic cardiomyopathy Follow-upvisit « Quick Look » screen Battery OK Leads OK 1 VT/VF treated

3. Programmable parameters

4. Fast atrial rate Slow ventricular rate VT or VF ATP No effect, VT or VF 2 nd ATP VT Termination But shock ! Atrial Tachycardia termination Episode end

5. Atrial tachyarrhythmia Slow ventricular rate V acceleration Bi-tachycardiadetected ATP

6. Failure of 1st ATP VF diagnosed Charge stillgoing VT stopped Charge end

7. 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 !