Automatic adjustment of ventricular antitachycardia pacing and individualized device therapy
Rajiv Tripathi, Christopher Gubran, Craig Jeavons
Abstract
Key Teaching Points•Antitachycardia pacing (ATP) is a safe, pain-free, and effective method of terminating ventricular tachycardias.•There are several different algorithms of ATP; the most frequently programmed are burst and ramp. Burst pacing is a train of impulses with equal interstimulus intervals. Ramp is a train of impulses with decrementing interstimulus intervals.•While ATP is an important tool in the arsenal of treating ventricular arrhythmia, it may not work for all tachycardias; consider the substrate being treated as well.•In some cases, such as arrhythmogenic right ventricular dysplasia, ramp pacing was found to be much less effective than burst pacing in terminating tachycardia as well as having a higher probability of acceleration.•Intrinsic ATP is a new algorithm present in Medtronic defibrillators that allows for the delivery of patient- and arrhythmia-specific therapy by using calculations based on the tachycardia cycle length and origin to determine the most accurate pacing timing to terminate the tachycardia. •Antitachycardia pacing (ATP) is a safe, pain-free, and effective method of terminating ventricular tachycardias.•There are several different algorithms of ATP; the most frequently programmed are burst and ramp. Burst pacing is a train of impulses with equal interstimulus intervals. Ramp is a train of impulses with decrementing interstimulus intervals.•While ATP is an important tool in the arsenal of treating ventricular arrhythmia, it may not work for all tachycardias; consider the substrate being treated as well.•In some cases, such as arrhythmogenic right ventricular dysplasia, ramp pacing was found to be much less effective than burst pacing in terminating tachycardia as well as having a higher probability of acceleration.•Intrinsic ATP is a new algorithm present in Medtronic defibrillators that allows for the delivery of patient- and arrhythmia-specific therapy by using calculations based on the tachycardia cycle length and origin to determine the most accurate pacing timing to terminate the tachycardia.