Pacemaker endless loop tachycardia: termination by simple techniques other than magnet application

Pacemaker endless loop (or reentrant) tachycardia (ELT) is often terminated by conversion to the asynchronous mode of pacing by simply placing a magnet over the implanted atrial tracking (DDD or VDD) pacemaker. We investigated three other simple methods of ELT termination—chest wall stimulation (CWS), provocation of myopotential oversensing, and chest thumping—that may be useful when the arrhythmia is unresponsive to magnet application or a magnet is unavailable. A modified CWS technique using an external pulse generator (pulse width = 40 msec) ordinarily used for transcutaneous cardiac pacing was tested in 74 patients (40 with unipolar and 34 with bipolar DDD devices). CWS inhibited the ventricular channel of all DDD pacemakers easily and reliably. CWS was then applied during ELT in 20 patients (10 with unipolar and 10 with bipolar DDD devices). Provocation of myopotential oversensing by the ventricular channel was attempted during ELT in 10 patients with unipolar DDD pacemakers. Chest thumping was tried during ELT in six patients. CWS by the modified technique terminated ELT in all patients in whom the arrhythmia was induced. Myopotential oversensing resulted in successful ELT termination in six of the 10 patients. ELT was successfully terminated by chest thumping in four of six patients. These simple techniques provide effective ways of ELT termination other than magnet application, and may be easily applied by physicians unfamiliar with the complexities of contemporary DDD pacemakers and their programmers.