Morphology of Far‐Field Electrograms and Antitachycardia Pacing Effectiveness Among Fast Ventricular Tachycardias Occurring in ICD Patients: A Multicenter Study

Jiménez‐Candil, Javier; Anguera, Ignasi; Ledesma, Claudio; Portales, Javier Fernández; Moríñigo, José Luis; Dallaglio, Paolo; Martín, Ana; Cano, Teresa Rodríguez; Hernández, Jesús; Sabaté, Xavier; Martín-Luengo, Cándido

doi:10.1111/jce.12228

Cited by 11 publications

(17 citation statements)

References 29 publications

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“…In our study population, VT cycle length, ATP pacing rate, cycle length variability, and EGM‐morphology did not predict ATP efficacy. In agreement with previous reports, beta‐blockers improved the success rate of ATP. Indeed, beta‐blockers prolong the excitable gap, thereby facilitating ATP to enter in the VT circuit …”

Section: Discussionsupporting

confidence: 92%

Safety and efficacy of anti‐tachycardia pacing in patients with hypertrophic cardiomyopathy implanted with an ICD

Adduci

Semprini

Palano

et al. 2019

Pacing Clinical Electrophis

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Background In hypertrophic cardiomyopathy (HCM) patients implanted with an implantable cardioverter defibrillator (ICD), clinical outcomes of antitachycardia pacing (ATP) have been poorly explored. In a retrospective analysis of a cohort of consecutive HCM patients implanted with an ICD, we aimed to assess the efficacy, safety, and clinical value of ATP. Methods The cohort of HCM patients implanted with a transvenous ICD and followed in our center was assessed for device intervention from implantation to last clinical follow‐up. Results Overall 77 patients (45 males; mean age: 46 ± 16 years) were analyzed. After 67 ± 41 months, 24 patients had 49 ventricular tachycardia/fibrillation (VT/VF) appropriately treated (5.8% per year). Among 39 monomorphic VTs, ATP was effective in 27 (success rate: 69%). Mean time from VT onset to ATP delivery was 9.1 ± 4.9 s. The only clinical variable improving ATP success was use of beta‐blockers (81% vs 50%; P = .04). Out of 12 ineffectively treated VTs, one was immediately shocked, four self‐terminated after 18 ± 12 s, and seven (18%) were accelerated to a new VT. ATP was also delivered for 27 of 42 inappropriately detected episodes and induced two de novo VTs (7%). In the per patient analysis, 14 out 77 (18%) patients had one or more appropriate and effective ATP (3.4% per year), and only six (8%; 1.4% per year) received more than one ATP. Conclusion ATP is moderately effective for the treatment of monomorphic VTs in HCM patients. However, the rate of appropriate ATP therapies is low, ATP is often prematurely delivered, and ATP‐induced arrhythmia degeneration is of concern.

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Section: Discussionsupporting

confidence: 92%

Safety and efficacy of anti‐tachycardia pacing in patients with hypertrophic cardiomyopathy implanted with an ICD

Adduci

Semprini

Palano

et al. 2019

Pacing Clinical Electrophis

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“…This is true in both PP and SP patients [4,14]. In addition, almost one third of such events are fast VT with a CL below 320 ms [15,4,16]. Since such VTs are due to a re-entrant mechanism, the majority of ventricular episodes are potentially ATP-terminable.…”

Section: Ventricular Tachyarrhythmias Causing Appropriate Therapiesmentioning

confidence: 97%

Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms

Jiménez‐Candil

Hernández

Martín

et al. 2015

J Interv Card Electrophysiol

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“…Normally, the electrograms used by the sensing algorithms are high-pass filtered, while those recorded for diagnostic applications include lower frequency components. Some ICDs offer in addition the possibility to record "far-field electrograms" between the defibrillation coil and the stimulator can, besides the standard "near-field signals" derived by the pacing electrodes, in the aim to better recognize wide and narrow QRS complexes, which in turn would orient the diagnosis toward a VT or SVT, respectively 5,6 . An alternative approach to far-field sensing, which can be accomplished in pacemakers and.…”

Section: Signalsmentioning

confidence: 99%

Basic Properties And Clinical Applications Of The Intracardiac

Zanon

Marcantoni

Pastore

et al. 2016

Journal of Atrial Fibrillation

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signals.2-4 However, the morphological evaluation of ventricular waveforms can add further insight, and is feasible even with a singlechamber stimulator. To this purpose, the electrogram filter bandwidth must be enlarged and the sensitivity to remote phenomena increased, at the expense of specificity. Normally, the electrograms used by the sensing algorithms are high-pass filtered, while those recorded for diagnostic applications include lower frequency components. Some ICDs offer in addition the possibility to record "far-field electrograms" between the defibrillation coil and the stimulator can, besides the standard "near-field signals" derived by the pacing electrodes, in the aim to better recognize wide and narrow QRS complexes, which in turn would orient the diagnosis toward a VT or SVT, respectively 5,6 . An alternative approach to far-field sensing, which can be accomplished in pacemakers and. ICDs as well, has recently been developed and referred to as intracardiac ECG (iECG) [7][8][9][10] . The iECG tracing closely resembles a surface ECG lead, featuring striking different waveforms in case of physiological AV conduction along the His-Purkinje pathway, left or right bundle branch block (LBBB, RBBB), idioventricular rhythm or ectopic ventricular beats (PVC). If the ventricle is paced, the ventricular component of the iECG depends on the stimulation target, which can therefore be identified. In the event of a tachycardia, the iECG allows reliable discrimination of VTs and SVTs, providing in addition detailed information on pre-excitation and retrograde AV conduction 7,8. The main properties of the iECG and its actual and potential applications in the clinical setting are reviewed in the present paper.www.jafib.com AbstractThe electric signals detected by intracardiac electrodes provide information on the occurrence and timing of myocardial depolarization, but are not generally helpful to characterize the nature and origin of the sensed event. A novel recording technique referred to as intracardiac ECG (iECG) has overcome this limitation. The iECG is a multipolar signal, which combines the input from both atrial and ventricular electrodes of a dual-chamber pacing system in order to assess the global electric activity of the heart. The tracing resembles a surface ECG lead, featuring P, QRS and T waves. The time-course of the waveform representing ventricular depolarization (iQRS) does correspond to the timecourse of the surface QRS with any ventricular activation modality. Morphological variants of the iQRS waveform are specifically associated with each activity pattern, which can therefore be diagnosed by evaluation of the iECG tracing. In the event of tachycardia, SVTs with narrow QRS can be distinguished from other arrhythmia forms based upon the preservation of the same iQRS waveform recorded in sinus rhythm. In ventricular capture surveillance, real pacing failure can be reliably discriminated from fusion beats by the analysis of the area delimited by the iQRS signal. Assessing the iQRS waveform cor...

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Morphology of Far‐Field Electrograms and Antitachycardia Pacing Effectiveness Among Fast Ventricular Tachycardias Occurring in ICD Patients: A Multicenter Study

Abstract: Since ATP is less effective in non-QFVTs, they are less well tolerated. Therefore, the substrate of non-QFVTs may need a specific treatment.

Cited by 11 publications

References 29 publications

Safety and efficacy of anti‐tachycardia pacing in patients with hypertrophic cardiomyopathy implanted with an ICD

Safety and efficacy of anti‐tachycardia pacing in patients with hypertrophic cardiomyopathy implanted with an ICD

Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms

Basic Properties And Clinical Applications Of The Intracardiac

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