CHALLENGE OF THE WEEK See Answer to February 5th Following Question Amit Noheria, MBBS, SM Phillip S. Cuculich, MD A 56-year-old man with ischemic cardiomyopathy, left ventricular ejection frac- tion 30%, New York Heart Association class III symptoms on optimal medical therapy, dual-chamber implanted cardioverter defibrillator in place, and chron- ic kidney disease stage 4 (creatinine clearance, 20 mL/min) presents to the office after 3 implanted cardioverter defibrillator shocks. Baseline ECG shows first-degree heart block and QRS duration 115 ms. He has a dual-chamber implanted cardioverter defibrillator. On device interrogation, all 3 episodes are similar; a representative episode is shown (Figures 1 and 2). What is the most appropriate next step? Circ Arrhythm Electrophysiol is available at http://circep. Figure 1. Representative device-stored episode that resulted in defibrillator shock. ahajournals.org. Contentious strips are shown with atrial electrogram (Atip to Aring), ventricular electro- gram (RVtip to RVring), and marker channel with atrioatrial (A-A) and ventriculoventricular © 2018 American Heart (V-V) intervals as classifed by the device. Association, Inc. Circ Arrhythm Electrophysiol. 2018;11:e006209. DOI: 10.1161/CIRCEP.118.006209 February 2018 1 Noheria and Cuculich; Challenge of the Week Figure 2. Box plot of the episode shown in Figure 1. Answer Options A. Increase β-blocker B.
Circulation: Arrhythmia & Electrophysiology – Wolters Kluwer Health
Published: Feb 1, 2018
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