Clinical course and prognostic relevance of antitachycardia pacing-terminated ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients

The unpredictable nature and potentially catastrophic consequences of ventricular arrhythmias (VAs) have obligated physicians to search for therapies to prevent sudden cardiac death (SCD). At present, a low left ventricular ejection fraction (LVEF) has been used as a risk factor to predict SCD in patients with structural heart disease and has been consistently adopted as the predominant, and sometimes sole, indication for implantable cardioverter defibrillator (ICD) therapy. Although the ICD remains the mainstay life-saving therapy for SCD, it does not modify the underlying arrhythmic substrate and may be associated with adverse effects from perioperative and long-term complications. Preventative pharmacological therapy has been associated with limited benefits, but anti-arrhythmic medications have significant side effects profiles. Catheter ablation of VAs has greatly evolved over the last few decades. Substrate mapping in sinus rhythm has allowed haemodynamically unstable VAs to be successfully treated. Both LVEF as an indication for ICD therapy and electro-anatomical mapping for substrate modification identify static components of underlying myocardial arrhythmogenicity.

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“…A similar conclusion can be drawn from a recent study that shows an increase in mortality in patients receiving ATP therapy (Kleemann et al . ).…”

Section: Introductionmentioning

confidence: 97%

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Proietti

Joza

Essebag

2016

The Journal of Physiology

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“…Information about the impact of diabetes was however not provided. In a recent report from the single-center ICD-registry Ludwigshafen [81], the impact of antitachycardia (ATP)-therapy for VT on mortality in patients implanted with ICD, predominantly (75%) for secondary prevention of SCD, was described. About three-fourths of the 17,827 episodes of ventricular arrhythmias (in 749 patients) documented over a median follow-up of 6 years were terminated by ATP.…”

Section: Risk Of Inappropriate and Appropriate Icd Therapy In Diabeticsmentioning

confidence: 99%

Implantable cardioverter defibrillators in diabetics: efficacy and safety in patients at risk of sudden cardiac death

Shahreyar¹,

Mupiddi

Choudhuri

et al. 2015

Expert Review of Cardiovascular Therapy

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Summary Diabetes mellitus is a major risk factor for arrhythmogenesis and is associated with a 2-fold increase in all-cause mortality and a 4-fold increase in cardiovascular mortality including sudden cardiac death when compared to nondiabetics. Implantable cardioverter defibrillators (ICD) have been shown to effectively reduce arrhythmic death and all-cause mortality in patients with severe myocardial dysfunction. With a high competing risk of nonarrhythmic cardiac and noncardiac death, survival benefit of ICD in patients with diabetes mellitus could be reduced, but the sub-analysis of diabetic patients in randomized clinical trials provides reassurance regarding a similar beneficial survival effect of ICD and cardiac resynchronization therapy in diabetics, as observed in the overall population with advanced heart disease. In this article, the authors highlight some of the clinical issues related to diabetes, summarize the data on the efficacy of ICD in diabetics when compared to nondiabetics and discuss concerns related to ICD implantation in patients with diabetes.

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“…Similarly, a second retrospective analysis evaluated outcomes after ATP therapy in 1398 (68% secondary prevention and 32% primary prevention) patients with a median of 6 years of followup. 35 This cohort of patients had VT that received an ICD intervention in 749 (54%) patients. A multivariable model compared patients treated with ATP only and those patients with no ICD interventions, and ATP was associated with higher morality with a HR of 1.92 (95% CI 1.38-2.67).…”

Section: Outcomes After Appropriate Antitachycardia Pacingmentioning

confidence: 99%

Management of Pace-Terminated Ventricular Arrhythmias

Pokorney

Al‐Khatib

2015

Cardiac Electrophysiology Clinics

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Clinical course and prognostic relevance of antitachycardia pacing-terminated ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients

Abstract: In ICD patients, about three-fourths of ventricular arrhythmias are terminated by ATP. The occurrence of ATP-terminated episode is associated with an increased mortality rate.

Cited by 18 publications

References 21 publications

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Implantable cardioverter defibrillators in diabetics: efficacy and safety in patients at risk of sudden cardiac death

Management of Pace-Terminated Ventricular Arrhythmias

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