Combined bipolar dual chamber pacing and automatic implantable cardioverter/defibrillator.

A 67 year old man with recurrent hypotensive ventricular tachycardia, amiodarone-induced bradyarrhythmias and severe cardiac dysfunction underwent simultaneous implantation of an automatic cardioverter/defibrillator and bipolar atrioventricular (AV) pacemaker. The pacing electrodes were placed epicardially near the right atrial appendage and on the lateral right ventricular wall. The rate detector of the automatic defibrillator was placed epicardially on the posterobasal left ventricular wall. Effective bipolar AV pacing produced no false counting of the heart rate by the automatic cardioverter/defibrillator, and ventricular tachycardia properly inhibited the pacemaker. Long-term follow-up study confirmed the safety of this treatment. With proper precautions, bipolar AV pacing can be safely combined with an automatic cardioverter/defibrillator.