Patient-activated anti-tachycardia pacing in adult congenital heart disease

Thomas Carberry*, Sabrina Tsao, Ahmad Sami Chaouki

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: In adults with congenital heart disease, intra-atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction. Methods: Retrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker. Results: Four adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual-chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow-up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation. Conclusion: This series demonstrates the use of TPARx software as part of a long-term IART management strategy in select patients with IART who have failed more conventional therapies.

Original languageEnglish (US)
Pages (from-to)711-716
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume45
Issue number6
DOIs
StatePublished - Jun 2022

Keywords

  • ACHD
  • Fontan
  • anti-tachycardia pacing
  • atrial tachycardia
  • pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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