[Technical problems posed by automatic treatment of arrhythmia by an implanted pacemaker].

Abstract

The automatic treatment of arrhythmias by cardiac pacemakers requires a phase of recognition of the arrhythmia followed by its treatment. Different factors limit the analysis and recognition ranging from the quality of detection of spontaneous events to the recognition of the arrhythmias. Bipolar dual chamber pacing is essential: it allows minimisation of the detection of interference or cross talk between the atrial and ventricular chambers and better discrimination of episodes of rapid rhythm. The treatment algorithms are multiple, difficult to investigate in the laboratory, and their efficacy varies with the evolution of the pathology or with medical treatment. There is not a single response but a programme where the antitachycardia modes of pacing succeed one another until the reduction of the arrhythmia. This instability of treatment implies a capacity of memorization with a double objective: to authorize a posteriori diagnosis of the treated pathology and to analyse the evolution of the antitachycardia response. These diagnostic functions are also dependent on the quality of detection and pacing. The automaticity of the treatment, when essential, can only be envisaged in patients available for strict and regular clinical follow-up.