Delivering ≥8 antitachycardia pacing sequences increased the cumulative success rate of terminating ventricular tachycardias to 87% compared to 71% with 1 sequence, and lowered shock burden.
Observational (n=2,770)
Does programming more antitachycardia pacing sequences improve the termination of ventricular tachycardias and reduce shock burden in patients with implantable cardioverter-defibrillators?
Programming more ATP sequences in ICD and CRT-D patients is associated with higher VT termination success and lower shock burden without increasing syncope.
Tasa de eventos absoluta: 87% vs 71%
BACKGROUND: Antitachycardia pacing (ATP) is an established implantable cardioverter-defibrillator (ICD) therapy that terminates ventricular tachycardias (VTs) without painful ICD shocks. However, factors influencing ATP success are not well understood. OBJECTIVE: The purpose of this study was to examine ATP success rates by patient, device, and programming characteristics. METHODS: This retrospective analysis of the PainFree SmartShock Technology study included spontaneous ATP-treated monomorphic VT episodes. ATP success rates were calculated for various factors. Also, the relationship of ATP programming on shock burden and syncope were investigated. RESULTS: Of the 2770 enrolled patients (2200 79% male; mean age 65 years), 1699 (61%) received an ICD and 1071 (39%) a cardiac resynchronization therapy - defibrillator. ATP had >80% rate of success for terminating VTs overall, with similar rates observed between ICD and cardiac resynchronization therapy - defibrillator devices (82.2% vs 80.3%, respectively; P = .81) as well as between primary and secondary prevention patients with ICDs (77.2% vs 83.9% respectively; P = .25). Arrhythmias with a median cycle length of ≥320 ms had a significantly higher ATP success rate (88.0%; 95% confidence interval 84.8%-90.6%). The cumulative percentage of ATP success increased from 71% at 1 ATP sequence delivered to 87% at ≥8 sequences delivered. Programming more ATP sequences was associated with lower shock burden (P = .0005). There was no evidence that more sequences were associated with higher rates of syncope (P = .16). CONCLUSION: Delivering more ATP sequences resulted in a higher overall success of terminating VTs, while programming more ATP was associated with decreased shock burden and no evidence of increased syncope or acceleration. This suggests that more ATP sequences should be programmed when possible, but confirmation in prospective studies will be necessary.
Sterns et al. (Wed,) conducted a observational in Ventricular tachycardias in patients with ICD or CRT-D (n=2,770). Antitachycardia pacing (ATP) vs. 1 sequence was evaluated on Cumulative percentage of ATP success for terminating VTs. Delivering ≥8 antitachycardia pacing sequences increased the cumulative success rate of terminating ventricular tachycardias to 87% compared to 71% with 1 sequence, and lowered shock burden.