How can tachyarrhythmias be managed with pacing?

• A. Pacing is never used in tachyarrhythmias.
• B. Overdrive pacing or pacing-termination strategies in select tachyarrhythmias; used in specific clinical scenarios.
• C. Pacing is the primary treatment for all tachyarrhythmias.
• D. Pacing is only diagnostic.

Answer: (B)

The idea being tested is that pacing can be used intentionally to control and terminate certain fast heart rhythms, rather than being something only used to diagnose. Overdrive pacing delivers stimuli at a faster rate than the tachycardia, with the goal of capturing the heart tissue and temporarily taking control of the electrical activity. By pacing faster than the abnormal rhythm, the normal conduction pathways can reset, the reentrant circuit can be disrupted, and the tachycardia can terminate. This is the principle behind anti-tachycardia pacing (ATP) delivered by devices like pacemakers or implantable cardioverter-defibrillators (ICDs), and it can also be used temporarily during an electrophysiology study or external pacing in the hospital.

This approach is not the universal or primary treatment for all tachyarrhythmias, and pacing isn’t purely diagnostic. Some tachyarrhythmias are better treated with drugs, ablation, or cardioversion, and many rhythms are managed with other strategies. When applicable, pacing serves as a targeted, rhythm-specific tool to suppress or terminate the abnormal rapid rhythm in selected clinical scenarios.