Introduction: After T-wave shock induction test, we observe VF pattern in ECG, but in the available IEGM inflections it shows sinus rhythm for RA, an unstable ventricular tachycardia with 155 bpm for the RV, and a stable LV rhythm at 250 bpm.
Methods: Patient stratified as MADIT II for isquemic cardiomyopathy, diabetes mellitus with insulin dependent. The patient was cocaine user, 17% EF, Previous MI 8 years ago without reperfusion therapy. During device implantation (Fig. 1), and induction with T-wave shock, presented dissociated rhythms in the 3 chambers.
Results: Presented in the Figure 2, we observe total rhythm dissociation in the 3 chambers and VF pattern in the ECG. The automatic shock therapy (at 182bpm) was not delivered, and then proceeds in manual therapy rescue with the device programmer.
Conclusions: The actual CRT-D technology only allows delivery shock when the RV frequency rise up the programmed VF zone, but in this case, was not enough. We need to start to look at LV for arrhythmia detection.