Key result
Among primary prevention ICD patients, ATP-associated termination of monomorphic ventricular tachycardia was similar between those with ischemic and nonischemic cardiomyopathy (74.6% vs. 76.4%; p=0.58).
Why the study?
Whether antitachycardia pacing is equally effective in ischemic versus nonischemic cardiomyopathy patients remains poorly understood.
Does antitachycardia pacing (ATP) improve arrhythmia termination equally in primary prevention ICD patients with ischemic versus nonischemic cardiomyopathy?
Meta-Analysis (n=6,126)
Yes
Does antitachycardia pacing (ATP) improve arrhythmia termination equally in primary prevention ICD patients with ischemic versus nonischemic cardiomyopathy?
Antitachycardia pacing is equally effective in terminating monomorphic ventricular tachycardia in primary prevention ICD patients regardless of whether they have ischemic or nonischemic cardiomyopathy.
Supports uniform ATP programming in primary prevention ICDs regardless of etiology; confirms comparable efficacy between ischemic and nonischemic cardiomyopathy.
BACKGROUND: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. METHODS: tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240-310 ms) MVTs. RESULTS: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p = .28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p = .27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p = .58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240-310 ms) episodes (84.1% vs. 69%; p < .001). CONCLUSION: In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.
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Cheng et al. (2020) conducted a meta-analysis in Ischemic and nonischemic cardiomyopathy (n=6,126). Ischemic cardiomyopathy vs. Nonischemic cardiomyopathy was evaluated on ATP-associated termination of monomorphic ventricular tachycardia (p=0.58). Among primary prevention ICD patients, ATP-associated termination of monomorphic ventricular tachycardia was similar between those with ischemic and nonischemic cardiomyopathy (74.6% vs. 76.4%; p=0.58).
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