Pacemaker Therapy for Ventricular Tachycardia

Introduction to Pacemaker Therapy

• The American College of Cardiology and American Heart Association guidelines state that standard pacemakers are not effective for preventing ventricular tachycardia in the vast majority of patients, with serious or symptomatic ventricular arrhythmias rarely prevented by pacing alone 1, 2
• The American College of Cardiology recommends that pacemakers receive a Class II indication for long QT syndrome when combined with beta blockade, as continuous pacing prevents pause-dependent ventricular tachycardia in long QT patients 1, 3, 4, 5, 6

Indications and Contraindications for Pacemaker Therapy

• The American College of Cardiology and American Heart Association guidelines classify as Class III (not indicated) the use of pacemakers for frequent or complex ventricular ectopic activity without sustained VTach in patients with coronary artery disease, cardiomyopathy, mitral valve prolapse, or normal hearts 4, 5, 6
• The American College of Cardiology recommends that pacemakers are not appropriate for general prevention of life-threatening ventricular arrhythmias, as they are not effective in preventing or treating life-threatening ventricular arrhythmias 7

Role of Antitachycardia Pacing and ICD Therapy

• The American College of Cardiology and American Heart Association guidelines state that antitachycardia pacing can terminate certain reentrant ventricular tachycardias through programmed stimulation or rapid pacing bursts, but permanent antitachycardia pacing as monotherapy for VTach is not appropriate 1, 2
• The American Heart Association recommends that an implantable cardioverter-defibrillator (ICD) is the appropriate device for patients with life-threatening ventricular arrhythmias, not a standard pacemaker, as ICDs effectively prevent sudden cardiac death in patients at risk for life-threatening ventricular tachyarrhythmias 4, 5, 6

Safety Concerns and Patient Selection

• The American College of Cardiology and American Heart Association guidelines state that pacemakers can accelerate tachycardia or convert it to ventricular fibrillation, and tachycardias that are accelerated or converted to fibrillation by pacing are a Class III contraindication 4, 5, 6
• The American College of Cardiology recommends that patients must have failed or be intolerant of antiarrhythmic drugs, and the decision requires careful observation and electrophysiologic study by experienced specialists, with efficacy of pacing thoroughly documented before implantation 4, 5, 1, 2