Antitachycardia Pacing for Fast Scar-Mediated Ventricular Tachycardia Across Non-Ischemic Cardiomyopathies: A Case Series
Abstract
Background Fast monomorphic ventricular tachycardia (VT) in non-ischemic and inherited cardiomyopathies is frequently treated as an imminently shock-requiring rhythm. Yet ventricular rate is an imperfect surrogate for tachycardia mechanism. When VT remains regular, monomorphic, and sustained by an organized reentrant circuit with an accessible excitable gap, antitachycardia pacing (ATP) may terminate even very rapid episodes without high-energy shock delivery. Case Series We report five patients with distinct non-ischemic arrhythmogenic substrates in whom fast sustained monomorphic VT (≥188 beats/min; tachycardia cycle length ≤320 ms), including very fast/VF-zone events >250 beats/min, was successfully terminated by ATP. The phenotypes comprised LMNA cardiomyopathy with conduction disease and septal fibrosis; TTN truncating variant-associated dilated cardiomyopathy with VT at approximately 260 beats/min; δ-sarcoglycan-associated dilated cardiomyopathy with clustered VT/electrical storm; severe non-ischemic cardiomyopathy with left bundle branch block, CRT-D implantation, and circumferential ring-like fibrosis, followed by 27 early post-implant VT episodes all terminated by ATP; and hypertrophic cardiomyopathy with an apical left ventricular aneurysm and diffuse late gadolinium enhancement, complicated by shock-free electrical storm. Several episodes were asymptomatic or initially attributed to atrial arrhythmia, whereas device interrogation documented sustained VT requiring…
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