True septum right ventricular lead position was associated with a higher success rate of type-I break ventricular tachycardia termination than nonseptum positions (79.8% vs 60.5%; P=0.023).
Observational (n=119)
Do specific characteristics such as true septum lead position, CRTD use, and slower VT rates improve the success rate of antitachycardia pacing for terminating ventricular tachycardia?
True septum right ventricular lead placement, along with CRTD use and slower VT rates, significantly improves the success rate of antitachycardia pacing for terminating ventricular tachycardia.
Absolute Event Rate: 79.8% vs 60.5%
p-value: p=0.023
BACKGROUND: Antitachycardia pacing (ATP) has a potential benefit for shock reduction of implantable cardioverter-defibrillator (ICD) recipients; however, its clinical utility and characteristics are unknown. OBJECTIVES: This study aims to extract characteristics leading to a high ventricular tachycardia (VT) termination rate of ATP. METHODS: Patients who had a history of ≥1 ATP treatment episode from ICD or cardiac resynchronization therapy-defibrillator (CRTD) devices were included. All ATP treatments wherein intracardiac electrograms could be traced were reviewed. Two endpoints of VT termination were defined: type-I break (termination with 0-1 beat) and clinical endpoint of termination (≤5 beats). We assessed the characteristics associated with a high success rate of ATP using the logistic regression generalized estimating equation method. RESULTS: Of 756 recipients using high-power devices, 1,468 treatment episodes in 119 patients were analyzed. The VT rate of <188 beats/min (vs ≥188 beats/min), CRTD (vs ICD), and true septum right ventricular lead position were significantly associated with high success rate of type-I break termination (generalized estimating equation success rate: 78.7% vs 64.7%, P = 0.011; 80.1% vs 66.5%, P = 0.021; and 79.8% vs 60.5%, P = 0.023, respectively). True septum lead position and slow VT were also independently associated with successful termination with clinical endpoint. The termination rate was highest in the right ventricular true septum position across all positions at both endpoints. The pacing QRS interval was significantly shorter in the septum group than in the nonseptum group (166.2 ± 21.9 ms vs 198.7 ± 26.5 ms; P < 0.001). CONCLUSIONS: True septum lead position, in addition to slow VT and CRTD, may be key to high ATP termination success.
Yanagisawa et al. (Fri,) conducted a observational in Ventricular tachycardia (n=119). True septum right ventricular lead position vs. Nonseptum lead position was evaluated on Type-I break (termination with 0-1 beat) (p=0.023). True septum right ventricular lead position was associated with a higher success rate of type-I break ventricular tachycardia termination than nonseptum positions (79.8% vs 60.5%; P=0.023).