Slow ventricular tachycardia in a 91-year-old man with implantable cardioverter-defibrillator and acute respiratory failure

• Published in: The American journal of emergency medicine 2017-08, Vol.35 (8), p.1213.e5-1213.e8
• Main Authors: Vargas, Nicola, Tibullo, Loredana, Landi, Cesare A.E., Carifi, Giovanni, Landi, Emanuela, Salsano, Elisa, Di Grezia, Francesco, Candelmo, Fiore
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Blood pressure; Cardiac arrhythmia; Cardiology; Cardiovascular diseases; Case reports; Continuous Positive Airway Pressure; Defibrillators; Defibrillators, Implantable; Drowsiness; Elderly adult patients; Emergency medical care; Family medical history; Fibrillation; Geriatrics; Heart diseases; Heart failure; Humans; Hypnotics and Sedatives - therapeutic use; ICD; Incidence; Male; Mens health; Midazolam - therapeutic use; Older people; Patients; Respiratory failure; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - therapy; Sleep Stages; Slow ventricular tachycardia; Tachycardia; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Treatment Outcome; Ventricle; Ventricular Fibrillation - complications; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.05.009

Slow ventricular tachycardia (VT) in patients with devices such as an implantable cardioverter - defibrillator (ICD) is more common than in the rest of the population. The incidence in elderly patients with an ICD remains largely unknown. In younger patients, slow VT is generally asymptomatic or associated with limited clinical relevance. It may be efficiently and safely terminated by anti-tachycardia pacing. We present a case of slow VT in a 91-year-old man with ICD with type 1 acute respiratory failure and drowsiness. Very elderly patients who have poor cardiac reserve and minor deterioration in cardiac function can face serious consequences such as ventricular fibrillation, cardiac arrest, and sudden cardiac death. The persistent ventricular rhythm may have a deleterious effect on their haemodynamic status, with potential aggravation of symptoms of heart failure and further impairment of ventricular function.