Very fast ventricular tachycardia can sometimes be stopped without a shock

Fast monomorphic ventricular tachycardia is often treated as a rhythm that inevitably needs a shock. This case series of five patients with different non-ischemic cardiomyopathies challenges that assumption.

The patients had LMNA, TTN and δ-sarcoglycan-related dilated cardiomyopathy, severe non-ischemic cardiomyopathy with a CRT-D, and hypertrophic cardiomyopathy with an apical aneurysm. Their sustained, regular VT reached at least 188 beats/min, and in some cases exceeded 250 beats/min. Antitachycardia pacing terminated these episodes. In one patient, all 27 early post-implant episodes were terminated this way. Some episodes were asymptomatic or first thought to be atrial arrhythmia until device interrogation showed VT.

The authors argue that heart rate is an imperfect predictor of whether pacing will work. As a five-patient case series, it cannot show how often this succeeds, and the cases may have been selected for success.