A Randomized Study to Compare Ramp Versus Burst Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators

Gulizia, Michele Massimo; Piraino, Leandro G; Scherillo, Marino; Puntrello, Calogero; Vasco, Calogero; Scianaro, Maria Carmela; Mascia, F; Pensabene, Orazio; Giglia, Salvatore; Chiarandà, Giacomo; Vaccaro, Ignazio; Mangiameli, S; Corrao, Dario; Santi, Elisabetta; Grammatico, Andrea

doi:10.1161/circep.108.804211

Cited by 78 publications

(72 citation statements)

References 32 publications

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“…The PITAGORA ICD clinical trial randomized 206 patients with an ICD to 2 ATP strategies: an 88% coupling interval burst vs a 91% coupling interval ramp. The results of the trial showed that over a median follow-up of 36 months and compared with ramp pacing, burst pacing was more effective for terminating fast VT episodes (between CL 240 and 320 ms) [170]. In a prospective study of 602 patients, a strategy of tiered ATP and low-energy shock was efficacious and safe in patients with VT CL greater than 250 ms, with extremely low syncope rates [171].…”

Section: Tachycardia Therapy Programmingmentioning

confidence: 99%

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

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Section: Tachycardia Therapy Programmingmentioning

confidence: 99%

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

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“…A randomized controlled trial reported that for FVT, adaptive burst pacing at 88% of the VT cycle length was more effective than ramp pacing and caused less acceleration. 44 Generally, shorter adaptive burst cycle lengths of 75% to 84% are required for slower VTs. In patients receiving cardiac resynchronization therapy, left ventricular (LV) or biventricular ATP may improve efficacy.…”

Section: Therapy and Therapy-zone Boundariesmentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

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“…Burst and ramp pacing have similar efficacy and safety for slow VT; however, for fast VT, burst pacing may offer greater efficacy and smaller probability of acceleration and is generally preferred. [46][47][48] The rate of ATP is typically programmed at 69% to 88% of VT cycle length, with similar efficacy and safety in this range. Each drive train typically has 8 stimuli, with a rapid decline in efficacy beyond 10 stimuli.…”

Section: Antitachycardia Pacingmentioning

confidence: 99%

Optimal Programming of Implantable Cardiac-Defibrillators

Madhavan

Friedman

2013

Circulation

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A Randomized Study to Compare Ramp Versus Burst Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators

Cited by 78 publications

References 32 publications

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Optimal Programming of Implantable Cardiac-Defibrillators

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