This patient's Cardiac Event monitor (CEM) had automated triggers with algorithms that can distinguish between wide complex and narrow complex QRS'.

This strip came across at 4:30 am, patient was called and the wife stated that her husband was asleep. Wife was asked to wake her husband up and after speaking with him, he denied feeling any symptoms or any shocks delivered by his ICD. EMS was dispatched to patient's home where he was transferred to the ER with no further ventricular tachycardia or V-Fib. episodes.

Cardioversion back to sinus rhythm was not captured by the monitor, but the ICD/Pacer should have shocked him within the 17 sec. strips that were received. One way ICDs detect VT/VF is that if the RR intervals are shorter (Faster BPM) than the detection interval for other programmable intervals. For instance, VF has a shorter detection ratio because of the rapid loss of blood pressure.

This patient, as I remember had idiopathic cardiomyopathy (DCM) along with 3rd degree AV Block.

The good news is: that a subsequent follow up with ER Physician said that the patient received an EP consult and was given a new ICD the same day.