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Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients?

Kenneth M. Stein, MD, FACC^*,*, David E. Euler, PhD, Rahul Mehra, PhD, Karlheinz Seidl, MD, David J. Slotwiner, MD^*, Suneet Mittal, MD, FACC^*, Steven M. Markowitz, MD, FACC^*, Bruce B. Lerman, MD, FACC^* Jewel AF Worldwide Investigators

^* Division of Cardiology, Department of Medicine, Cornell University Medical College, New York, New York, USA
Medtronic Inc., Minneapolis, Minnesota, USA
Herzentrum Ludwigshafen, Ludwigshafen, Germany

View larger version (61K): [in a new window]   Figure 1 Electrogram (Atip-Vring EGM) recording (0.5 mv/mm) at a chart speed 25 mm/s, showing a typical episode of dual tachycardia in one patient. Upward markers indicate atrial events; downward markers indicate ventricular events. The short triple atrial markers indicate ongoing atrial fibrillation (AF) detection (FD). Intermediate-height ventricular markers (VS) indicate sensed R-waves (VS); short double ventricular markers indicate ventricular fibrillation (VF) sense (FS); short triple markers indicates VF detection (FD). The vertical arrows show atrial activation complexes during device-defined AF. The short horizontal arrows show R-waves with intrinsic conduction. The ventricular rate accelerates abruptly; at the same time there is a change in the morphology of the ventricular electrogram (long horizontal arrow). The median RR interval of this device-defined VF episode was 260 ms.

View larger version (59K): [in a new window]   Figure 2 Electrogram (Atip-Vring EGM) recording (1 mv/mm) at a chart speed 25 mm/s, showing a typical episode of dual tachycardia from another patient. The markers are the same as in Figure 1. The vertical arrows show atrial activation complexes during device-defined atrial fibrillation. The short horizontal arrow shows an R-wave with intrinsic conduction. The ventricular rate accelerates abruptly; at the same time there is a change in the morphology of the ventricular electrogram (long horizontal arrow). The median RR interval of this device-defined ventricular fibrillation episode was 250 ms.