Supraventricular arrhythmias limit effective cardiac resynchronization therapy: Diagnosis using intracardiac electrograms and device based pacing maneuvers

Cardiac resynchronization therapy is an effective tool for the treatment of drug-refractory heart failure in patients with left ventricular dysfunction and inter/intra ventricular conduction delay. Supraventricular tachycardias may prevent effect delivery of this therapy. We report three cases in which effective therapy was limited by asymptomatic supraventricular tachycardia. Diagnostic pacing maneuvers were performed via the implanted device to determine the underlying arrhythmia mechanism. These cases highlight the importance of (1) treating supraventricular tachycardias before and after implantation of cardiac devices and (2) using device based programmed stimulation to diagnose the mechanism of supraventricular tachycardias.