A Technique for Intraoperative Arrhythmia Induction during Automatic Implantable Defibrillator Placement

In 14 patients (12 men, 2 women, mean age 51 +/- 4 years) we evaluated a new technique for intraoperative arrhythmia induction during Ventak 1550 automatic implantable cardioverter defibrillator (AICD), pulse generator placement. At the time of surgery (nine new implants, five pulse generator replacements), when the AICD pulse generator is in its final configuration with the rate sensing and patch electrodes leads inserted into the header, a #2 hex wrench was inserted into each of the rate sensing lead set screw sites. The alligator clips of a temporary pacing cable were placed on each of the hex wrenches and the remainder of the cable passed off field for attachment to a programmed stimulator or AC fibrillator. In all 14 patients, the clinical arrhythmia was induced at least twice (ventricular tachycardia in eight patients, ventricular fibrillation in six patients). No difficulties with arrhythmia induction or AICD sensing as discharge were encountered. We conclude that this technique is both a safe and effective means of intraoperative arrhythmia induction during placement or replacement in the Ventak AICD 1550 and 1600 series pulse generators.