Key result
Antitachycardia pacing alone successfully treated 63% of electrical storms, and patients receiving only ATP tended to have lower all-cause mortality compared to those requiring shocks (P=0.10).
Why the study?
The efficacy of ATP during an electrical storm and its impact on all-cause mortality had not been fully elucidated.
Does antitachycardia pacing alone improve all-cause mortality compared to shocks in patients with implantable defibrillators experiencing electrical storms?
Cohort (n=1,570)
Yes
Does antitachycardia pacing alone improve all-cause mortality compared to shocks in patients with implantable defibrillators experiencing electrical storms?
p-value: p=0.10
Antitachycardia pacing is effective in terminating electrical storms in ICD patients, avoiding painful shocks in over half of cases, with a trend toward lower mortality.
ATP terminated 63% of electrical storms without shocks; leaves open a mortality benefit in this observational cohort.
INTRODUCTION: Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all-cause mortality have not been fully elucidated. METHODS AND RESULTS: From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all-cause mortality were evaluated. During a median follow-up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00-1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01-1.06; p < .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all-cause mortality compared to those that required shocks during the ES (log-rank p = .10). CONCLUSIONS: ATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.
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Hayashi et al. (2021) conducted a cohort in Implantable cardioverter defibrillator (ICD) recipients with electrical storms (n=1,570). Antitachycardia pacing (ATP) alone vs. Shocks was evaluated on All-cause mortality (p=0.10). Antitachycardia pacing alone successfully treated 63% of electrical storms, and patients receiving only ATP tended to have lower all-cause mortality compared to those requiring shocks (P=0.10).
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