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Due to the increasing number of patients and complexity of modern tachycardia devices, efficient therapy monitoring as offered by telemedicine monitoring is of increasing importance. The potential advantages of remote control for patient management include early detection of device-related technical problems and arrhythmias. We report the case of an ICD patient with incessant ventricular tachycardia in whom immediate arrhythmia transmission was monitored by remote control.

Background: Although a low-energy cardioversion (LEC) shock from an implantable cardioverter-defibrillator (ICD) can terminate ventricular tachycardia (VT), it frequently triggers ventricular fibrillation (VF) and is therefore not used in clinical practice. We tested whether a modified LEC shock with a very short duration (0.12-0.36 ms), termed "field stimulus," can terminate VT without triggering VF., Methods: In 13 sedated patients with implanted ICDs, we attempted to induce VT and to terminate the arrhythmias by field stimuli during hospital predischarge tests., Results: In eight patients, 27 VT episodes were induced and treated with a total of 46 high-voltage (25-200 V) field stimuli, which terminated 11 VT episodes (41% efficacy) and never accelerated VT into VF. VT episodes slower than 230 beats per minute (bpm) (median rate) were terminated more successfully than faster arrhythmia episodes (69% vs 15%, P < 0.01). The strength of the field stimulus had no major influence on the effectiveness. We therefore postulate that suboptimal timing of field stimuli (delivered simultaneously with a sensed event in the right ventricular apex) was the main reason for failed VT terminations., Conclusion: A short (0.12-0.36 ms), high-voltage (50-100 V) field stimulus delivered from the shock coil of an implanted ICD system can safely terminate VT, especially for VT rates below 230 bpm. We believe that it would be reasonable to test the effectiveness of automatic field-stimulus therapy from implanted ICDs in VT episodes up to 230 bpm that are not susceptible to termination by antitachycardia pacing., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)