Empirical Versus Tested Antitachycardia Pacing in Implantable Cardioverter Defibrillators

Schaumann, Anselm; Mühlen, Friederike von zur; Herse, B.; Gonska, Bernd–Dieter; Kreuzer, H

doi:10.1161/01.cir.97.1.66

Cited by 153 publications

(99 citation statements)

References 24 publications

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“…Because previous studies have shown 90% to 96% ATP success rates for VT with CLϾ320 ms, [2][3][4][5][6][7][8] and these data demonstrated an ATP success rate of †Results adjusted for the occurrence of multiple episodes in the same patient.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,8 To successfully reset VT within the limit of ventricular refractory period, the pacing algorithm in this trial was set at a relatively nonaggressive 8 pulses at 88% VT CL, which yielded an acceleration rate of 4%. Although not desirable, this rate of acceleration compares favorably to previous studies that have shown acceleration rates between 7% and 18% for treatment of spontaneous rapid VT. 2,3 Given the greater success for FVT between 280 and 320 ms, it is possible that both success and acceleration could be improved by different CL cutoffs. The greatest danger may be that acceleration will lead to a rhythm refractory even to shocks.…”

Section: Discussionmentioning

confidence: 99%

“…1 Cardioversion shocks are very effective in terminating slow and fast VT (FVT) but are painful and impose considerable battery drain, whereas ATP is painless and has negligible battery drain. ATP has been shown to be effective in terminating 90% to 96% of episodes of spontaneous VT with cycle length (CL) Ͼ300 ms. [2][3][4][5][6][7][8] Many episodes labeled as VF by ICDs actually are rapid monomorphic VT. 9,10 Although evidence exists that ATP can effectively terminate some of these faster VTs, 2,3,5,8 these arrhythmias are usually treated with shocks because of concerns about efficacy, risk of acceleration, and syncope due to delay of definitive shock therapy. The objective of this study was to determine whether spontaneous FVT (CL 240 to 320 ms, 188 to 250 bpm) in patients with coronary artery disease (CAD) can be reliably and safely terminated by ATP, thus reducing painful shocks.…”

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confidence: 99%

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Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients With Coronary Artery Disease

et al. 2001

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Background-Implantable cardioverter-defibrillators (ICDs) can terminate some ventricular tachycardias (VTs) painlessly with antitachycardia pacing (ATP). ATP has not routinely been applied for VT Ͼ188 bpm because of concerns about efficacy, risk of acceleration, and delay of definitive shock therapy. This prospective, multicenter study evaluated the efficacy of empirical ATP to terminate fast VT (FVT; Ͼ188 bpm). Methods and Results-Two hundred twenty coronary artery disease patients received ICDs for standard indications.Empirical, standardized therapy was programmed so that all FVT episodes (average cycle length [CL] 240 to 320 ms, 250 to 188 bpm) were treated with 2 ATP sequences (8-pulse burst pacing train at 88% of the FVT CL) before shock delivery. A total of 1100 episodes of spontaneous ventricular tachyarrhythmias occurred during a mean of 6.9Ϯ3.6 months of follow-up. Fifty-seven percent were classified as slow VT (CLՆ320 ms), 40% as FVT (240 msՅCLϽ320 ms), and 3% as ventricular fibrillation (CLϽ240 ms). A total of 446 FVT episodes, mean CLϭ301Ϯ24 ms, occurred in 52 patients (median 2 episodes per patient). ATP terminated 396 FVT episodes (89%), with an adjusted efficacy of 77% (95% CI 68% to 83%). VT acceleration caused by ATP occurred in 10 FVT episodes (4%). FVT arrhythmic syncope occurred on 9 occasions (2%) in 4 patients. Conclusions-FVT (CLϽ320 ms) is common in ICD patients. ATP can terminate 3 of 4 of these episodes with a low incidence of acceleration and syncope. ATP for FVT may safely reduce the morbidity of painful shocks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients With Coronary Artery Disease

et al. 2001

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“…Given that ATP was programmed empirically, the results also support prior observations that "tailoring" based on electrophysiology study of induced VTs is not necessary in most situations. 10 No clinical predictors of ATP success could be found. Diminished left ventricular ejection fraction slightly reduced efficacy but reached only marginal statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Fast VT (FVT, 188 to 250 bpm) is typically programmed to receive painful shock therapy even though ATP might be successful. More recently, high success and low acceleration rates for FVT were demonstrated in coronary artery disease patients 10,11 but in a nonrandomized fashion, so a comparison with shocks for safety and QoL was not performed. This trial examined the efficacy, safety, and QoL associated with treatment of FVT with ATP compared with shocks in a broad ICD population.…”

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confidence: 99%

Prospective Randomized Multicenter Trial of Empirical Antitachycardia Pacing Versus Shocks for Spontaneous Rapid Ventricular Tachycardia in Patients With Implantable Cardioverter-Defibrillators

et al. 2004

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Background-Successful antitachycardia pacing (ATP) terminates ventricular tachycardia (VT) up to 250 bpm without the need for painful shocks in implantable cardioverter-defibrillator (ICD) patients. Fast VT (FVT) Ͼ200 bpm is often treated by shock because of safety concerns, however. This prospective, randomized, multicenter trial compares the safety and utility of empirical ATP with shocks for FVT in a broad ICD population. Methods and Results-We randomized 634 ICD patients to 2 arms-standardized empirical ATP (nϭ313) or shock (nϭ321)-for initial therapy of spontaneous FVT. ICDs were programmed to detect FVT when 18 of 24 intervals were 188 to 250 bpm and 0 of the last 8 intervals were Ͼ250 bpm. Initial FVT therapy was ATP (8 pulses, 88% of FVT cycle length) or shock at 10 J above the defibrillation threshold. Syncope and arrhythmic symptoms were collected through patient diaries and interviews. In 11Ϯ3 months of follow-up, 431 episodes of FVT occurred in 98 patients, representing 32% of ventricular tachyarrhythmias and 76% of those that would be detected as ventricular fibrillation and shocked with traditional ICD programming. ATP was effective in 229 of 284 episodes in the ATP arm (81%, 72% adjusted). Acceleration, episode duration, syncope, and sudden death were similar between arms. Quality of life, measured with the SF-36, improved in patients with FVT in both arms but more so in the ATP arm. Conclusions-Compared with shocks, empirical ATP for FVT is highly effective, is equally safe, and improves quality of life. ATP may be the preferred FVT therapy in most ICD patients.

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The ICD and How it Works

Clemo¹,

Ellenbogen²

2006

Implantable Cardiac Pacemakers and Defibrillators

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Empirical Versus Tested Antitachycardia Pacing in Implantable Cardioverter Defibrillators

Cited by 153 publications

References 24 publications

Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients With Coronary Artery Disease

Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients With Coronary Artery Disease

Prospective Randomized Multicenter Trial of Empirical Antitachycardia Pacing Versus Shocks for Spontaneous Rapid Ventricular Tachycardia in Patients With Implantable Cardioverter-Defibrillators

The ICD and How it Works

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