Resynchronization Therapy During Sustained Ventricular Tachycardia

A 62-year-old gentleman with a history of an ischemic cardiomyopathy and previous implantation of a biventricular cardioverter-defibrillator presented with complaints of palpitations and a wide complex ventricular paced rhythm at 120 bpm. This was originally thought to be ventricular tracking of an atrial tachycardia at the upper tracking rate, as the patient remained hemodynamically stable for three consecutive days in this rhythm. On the third day, the patient’s implantable cardioverter-defibrillator (ICD) was interrogated and it was found that he was indeed in a sustained ventricular tachycardia with biventricular pacing being delivered as a function of the ventricular sense response feature. When this feature was turned off, the patient immediately deteriorated hemodynamically and required a commanded shock through the ICD to terminate the tachycardia. This is an extremely rare presentation of this pacing feature found in biventricular ICDs, which in this case provided significant hemodynamic benefit during a malignant arrhythmia.