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Ventricular tachycardia: an unusual pacemaker-mediated tachycardia.
  1. D. C. Lefroy,
  2. T. Crake,
  3. D. W. Davies
  1. Department of Cardiac Medicine, National Heart and Lung Institute, London.


    A 74 year old man had recurrent ventricular tachycardia, which was well controlled with amiodarone, and complete heart block for which a VVI permanent pacing system had previously been implanted. After an elective increase in the programmed pacemaker rate from 70 to 82 beats/min, there was recurrence of frequent episodes of ventricular tachycardia. Each episode of tachycardia was initiated by a fusion beat consisting of a ventricular extrasystole and a paced beat. When the pacemaker rate was reprogrammed to 70 beats/min the episodes of tachycardia ceased abruptly. It is proposed that the fusion of a ventricular extrasystole with a pacemaker beat may have induced ventricular tachycardia, even though neither of these beats occurring separately was sufficient to cause this.

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