Unsuccessful Attempt to Terminate Vt by Atp Predicts Poor Clinical Outcome in Madit CRT Trial

Gibinski, Michal; Al‐Ahmad, Amin; Kutyifa, Valentina; McNitt, Scott; Goldenberg, Ilan; Wang, Paul; Klein, Hermann H.; Moss, Arthur J.; Zaręba, Wojciech

doi:10.1016/s0735-1097(11)60179-4

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“…Sweeney et al previously demonstrated that survival among patients successfully treated with ATP was identical to that of patients with no VT. 16 A sub-analysis of MADIT CRT demonstrated that patients with VT unresponsive to ATP had a higher risk of heart failure and death compared to patients who had VT with successful ATP termination. 17 In a more recent study of over 69 000 ICD patients, mortality was noted to be higher in patients receiving ATP compared to no therapy, however, mortality was highest in those receiving shock therapy. 18 Given these results, it can be postulated that failure to respond to ATP might reflect a more recalcitrant, persistent, rapid or recurrent arrhythmia possibly due to more advanced disease substrate.…”

Section: Introductionmentioning

confidence: 97%

Clinical predictors of antitachycardia pacing response in implantable cardioverter defibrillator patients

Harrison

Manola

Kalluri

et al. 2019

Pacing Clinical Electrophis

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Background Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success. Objective To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT. Methods The ICD clinic database was searched for monomorphic VT events requiring ICD therapy in patients with ischemic or non‐ischemic cardiomyopathy. Each patient's first ICD encounter for VT was assessed. Patient demographics, clinical characteristics, VT rate, and ATP responsiveness (always, sometimes, and never successful) were recorded. An ECG was analyzed for QRS morphology and duration. Data was assessed for predictors of ATP responsiveness. Results In 527 patients, characteristics associated with always successful ATP included ACE‐I/ARB therapy and slower VT rate (never successful ATP 197 ± 28 bpm, sometimes successful ATP 190 ± 27 bpm, always successful ATP 183 ± 22 bpm, P < .0001). Secondary prevention indication, amiodarone therapy, and longer QRS duration were associated with ATP failure. After multivariate analysis, only faster VT rate and amiodarone therapy were predictive of ATP failure. Conclusions Neither QRS morphology nor duration was predictive of ATP success. Slower VT rate was predictive of repeated ATP responsiveness. Amiodarone therapy, which is known to increase VT cycle length, interestingly was associated with ATP failure for unclear reasons. More individualized and possibly more aggressive ATP programming may be warranted in patients on amiodarone.

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Section: Introductionmentioning

confidence: 97%