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Hirahara AM, Khan MS, Gharbia O, Lange M, Ishidoya Y, Smego D, Ranjan R, Stoddard GJ, Selzman C, Dosdall DJ. Antitachycardia pacing at the His bundle is safer than conventional right ventricular antitachycardia pacing in a canine myocardial ischemic injury model. J Cardiovasc Electrophysiol 2023; 34:1249-1256. [PMID: 37125623 PMCID: PMC10259204 DOI: 10.1111/jce.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Antitachycardia pacing (ATP) is used to terminate ventricular tachycardia (VT) by delivering rapid, low energy pacing to the right ventricle (RV). Unfortunately, ATP is not effective against all VT episodes and can result in adverse outcomes, such as VT acceleration and degeneration into ventricular fibrillation (VF). Improving ATP is therefore desirable. Our objective was to compare the efficacy and safety of ATP delivered at the His bundle to traditional ATP. METHODS Six dogs were anesthetized and pacing leads were implanted in the RV and His bundle. The left anterior descending artery was occluded for 2 h to create an ischemic injury. In a study 4-7 days later, a 128-electrode sock was placed snugly around the ventricles and VT was induced using rapid pacing. ATP was delivered from either the His bundle or RV lead, then attempted at the other location if unsuccessful. Success rates and instances of VT acceleration and degeneration into VF were calculated. RESULTS We induced 83 runs of VT and attempted ATP 128 times. RV ATP was successful in 36% of attempts; His ATP was successful in 38% of attempts. RV ATP resulted in significantly more adverse outcomes. RV and His ATP induced VT acceleration in 9% and 3% of trains, respectively, and induced degeneration into VF in 5% and 1% of trains, respectively. CONCLUSION His bundle ATP is safer, but not significantly more effective, than RV ATP.
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Affiliation(s)
- Annie M Hirahara
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Muhammad S Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Omar Gharbia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Yuki Ishidoya
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Douglas Smego
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
| | - Gregory J Stoddard
- Clinical and Translational Science Institute, University of Utah, 375 Chipeta Way A, Salt Lake City, Utah, 84108 USA
| | - Craig Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
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Panchangam S, Monahan KM, Helm RH. Anti-tachycardia Pacing: Mechanism, History and Contemporary Implementation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chinushi M, Saitoh O, Furushima H, Aizawa Y, Noda T, Nitta T, Ohe T, Kurita T. Anti-tachycardia pacing for non-fast and fast ventricular tachycardias in individual Japanese patients: From Nippon-storm study. J Arrhythm 2021; 37:1038-1045. [PMID: 34386130 PMCID: PMC8339118 DOI: 10.1002/joa3.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-tachycardia pacing (ATP) delivered from an implantable device is a useful tool to terminate ventricular tachycardia (VT). But its real-world efficacy for those patients having multiple VTs with varying VT rates has not been fully studied. METHODS Using the Nippon-storm study database, efficacy of patient-by-patient basis ATP programing for Japanese patients having both non-fast (120-187 bpm) and fast VT (≥188 bpm) was assessed. According to the useful criteria of ≥50% success termination by ATP, patients were divided into three subgroups; success ≥50% for both non-fast and fast VT (both useful), ≥50% only for non-fast VT (non-fast VT useful), or ≥50% for neither non-fast nor fast VT (neither useful). RESULTS During a median follow-up of 28 months, ATP terminated 184 of the 203 non-fast VT episodes (91%) and 86 of the 113 fast VT episodes (76%) in all 41 patients. In the patient-by-patient analysis, efficacy of ATP was not different between non-fast and fast VT in most of the patients (36/41 = 88%); 32 patients were in the both useful and four other patients in the neither useful. Neither ischemic nor non-ischemic structural heart disease was associated with the ATP efficacy, whereas LVEF more than 37.0% and non-prescribed amiodarone were characteristics of the patients classified into the both useful. CONCLUSIONS ATP well terminated both non-fast and fast VT occurring in individual Japanese patients with various structural heart diseases in the real-world device treatment and this finding further supports ATP programing for all device tachycardia detection zones in most patients with multiple VTs.
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Affiliation(s)
- Masaomi Chinushi
- Cardiovascular Research of Graduate School of Health SciencesNiigataJapan
| | - Osamu Saitoh
- Cardiovascular Research of Graduate School of Health SciencesNiigataJapan
| | - Hiroshi Furushima
- Cardiovascular Research of Graduate School of Health SciencesNiigataJapan
| | - Yoshifusa Aizawa
- Department of Research and DevelopmentTachikawa Medical CenterNiigataJapan
| | - Takashi Noda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Takashi Nitta
- Department of Cardiovascular SurgeryNippon Medical SchoolTokyoJapan
| | | | - Takashi Kurita
- Department of Internal MedicineFaculty of MedicineKindai UniversityOsaka‐SayamaJapan
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Hayashi H, Shimizu W, Iwasaki Y, Yodogawa K, Noda T, Nitta T, Aizawa Y, Ohe T, Kurita T. Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators. J Cardiovasc Electrophysiol 2021; 32:823-831. [PMID: 33476454 DOI: 10.1111/jce.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all-cause mortality have not been fully elucidated. METHODS AND RESULTS From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all-cause mortality were evaluated. During a median follow-up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00-1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01-1.06; p < .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all-cause mortality compared to those that required shocks during the ES (log-rank p = .10). CONCLUSIONS ATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.
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Affiliation(s)
- Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Yoshifusa Aizawa
- Department of Research and Development, Tachikawa Medical Center, Niigata, Japan
| | - Tohru Ohe
- Okayama City Hospital, Okayama, Japan
| | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
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Jiménez-Candil J, Durán O, Núñez J, Bravo L, Hernández J, Martín-García A, Morínigo J, Sánchez PL. Effectiveness of first versus successive antitachycardia pacing attempts: predictors and clinical consequences. J Interv Card Electrophysiol 2019; 56:349-357. [DOI: 10.1007/s10840-019-00624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
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Harrison JW, Manola A, Kalluri LK, Duvall WL, Giedrimiene D, Kluger JW. Clinical predictors of antitachycardia pacing response in implantable cardioverter defibrillator patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1219-1225. [PMID: 31322287 DOI: 10.1111/pace.13760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
- Joshua W Harrison
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | - Akrivi Manola
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | | | - W Lane Duvall
- Division of Cardiology Hartford Hospital, Hartford, CT
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Connolly A, Williams S, Rhode K, Rinaldi CA, Bishop MJ. Conceptual Intra-Cardiac Electrode Configurations That Facilitate Directional Cardiac Stimulation for Optimal Electrotherapy. IEEE Trans Biomed Eng 2019; 66:1259-1268. [PMID: 31021745 PMCID: PMC7054045 DOI: 10.1109/tbme.2018.2871863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Electrotherapy remains the most effective direct therapy against lethal cardiac arrhythmias. When an arrhythmic event is sensed, either strong electric shocks or controlled rapid pacing is automatically applied directly to the heart via an implanted cardioverter defibrillator (ICDs). Despite their success, ICDs remain a highly non-optimal therapy: the strong shocks required for defibrillation cause significant extra-cardiac stimulation, resulting in pain and long-term tissue damage, and can also limit battery life. When used in anti-tachycardia pacing mode, ICDs are also often ineffective, as the pacing electrode can be far away from the centre of the arrhythmia, making it hard for the paced wave to interrupt and terminate it. METHODS In this paper, we present two conceptual intra-cardiac directional electrode configurations in silico based on novel arrangements of pairs of positive-negative electrodes. Both configurations have the potential to cause preferential excitation on specific regions of the heart. RESULTS We demonstrate how the properties of the induced field varies spatially around the electrodes and how it depends upon the specific arrangements of dipole electrode pairs. The results show that when tested within anatomically-realistic rabbit ventricular models, both electrode configurations produce strong virtual electrodes on the targeted endocardial surfaces, with weaker virtual electrodes produced elsewhere. CONCLUSIONS The proposed electrode configurations may facilitate targeted far-field anti-tachycardia pacing and/or defibrillation, which may be useful in cases where conventional anti-tachycardia pacing fails. In addition, the conceptual electrode designs intrinsically confine the electric field to the immediate vicinity of the electrodes, and may, thus, minimize pain due to unnecessary extra-cardiac stimulation.
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Adduci C, Semprini L, Palano F, Musumeci MB, Volpe M, Autore C, Francia P. Safety and efficacy of anti-tachycardia pacing in patients with hypertrophic cardiomyopathy implanted with an ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:610-616. [PMID: 30903669 DOI: 10.1111/pace.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
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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Affiliation(s)
- Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Lorenzo Semprini
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesca Palano
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy.,IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - Maria Beatrice Musumeci
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Camillo Autore
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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Dallaglio PD, Anguera I, Martínez Ferrer JB, Pérez L, Viñolas X, Porres JM, Fontenla A, Alzueta J, Martínez JG, Rodríguez A, Basterra N, Sabaté X. Taquicardias ventriculares rápidas en pacientes con desfibrilador implantable: reducción de choques mediante terapia antitaquicárdica antes y durante la carga. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Dallaglio PD, Anguera I, Martínez Ferrer JB, Pérez L, Viñolas X, Porres JM, Fontenla A, Alzueta J, Martínez JG, Rodríguez A, Basterra N, Sabaté X. Shock Reduction With Antitachycardia Pacing Before and During Charging for Fast Ventricular Tachycardias in Patients With Implantable Defibrillators. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 71:709-717. [PMID: 29242102 DOI: 10.1016/j.rec.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator are susceptible to antitachycardia pacing (ATP) termination. Some manufacturers allow programming 2 ATP bursts: before charging (BC) and during (DC) charging. The aim of this study was to describe the safety and effectiveness of ATP BC and DC for fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator in daily clinical practice. METHODS Data proceeded from the multicenter UMBRELLA trial, including implantable cardioverter-defibrillator patients followed up by the CareLink monitoring system. Fast ventricular tachycardias in the ventricular fibrillation zone until a cycle length of 200ms with ATP BC and/or ATP DC were included. RESULTS We reviewed 542 episodes in 240 patients. Two ATP bursts (BC/DC) were programmed in 291 episodes (53.7%, 87 patients), while 251 episodes (46.3%, 153 patients) had 1 ATP burst only DC. The number of episodes terminated by 1 ATP DC was 139, representing 55.4% effectiveness (generalized estimating equation-adjusted 60.4%). There were 256 episodes terminated by 1 or 2 ATP (BC/DC), representing 88% effectiveness (generalized estimating equation-adjusted 79.3%); the OR for ATP effectiveness BC/DC vs DC was 2.5, 95%CI, 1.5-4.1; P <.001. Shocked episodes were 112 (45%) for ATP DC vs 35 (12%) for ATP BC/DC, representing an absolute reduction of 73%. The mean shocked episode duration was 16seconds for ATP DC vs 19seconds for ATP BC/DC (P=.07). CONCLUSIONS The ATP DC in the ventricular fibrillation zone for fast ventricular tachycardia is moderately effective. Adding an ATP burst BC increases the overall effectiveness, reduces the need for shocks, and does not prolong episode duration.
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Affiliation(s)
- Paolo Domenico Dallaglio
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ignasi Anguera
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luisa Pérez
- Servicio de Cardiología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Xavier Viñolas
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Manuel Porres
- Servicio de Cardiología, Hospital Universitario de Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - Adolfo Fontenla
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Alzueta
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan Gabriel Martínez
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Aníbal Rodríguez
- Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Nuria Basterra
- Servicio de Cardiología, Hospital de Navarra, Pamplona, Navarra, Spain
| | - Xavier Sabaté
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Yee R, Fisher JD, Birgersdotter-Green U, Smith TW, Kenigsberg DN, Canby R, Jackson T, Taepke R, DeGroot P. Initial Clinical Experience With a New Automated Antitachycardia Pacing Algorithm. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004823. [DOI: 10.1161/circep.116.004823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Abstract
Background:
Antitachycardia pacing (ATP) in implantable cardioverter-defibrillators (ICD) decreases patient shock burden but has recognized limitations. A new automated ATP (AATP) based on electrophysiological first principles was designed. The study objective was to assess the feasibility and safety of AATP in ambulatory ICD patients.
Methods and Results:
Enrolled patients had dual chamber or cardiac resynchronization therapy ICDs, history of ≥1 ICD-treated ventricular tachycardias (VT)/ventricular fibrillation episode, or a recorded, sustained monomorphic VT. Detection was set to ventricular fibrillation number of intervals to detect=24/32, VT number of intervals to detect≥16, and a fast VT zone of 240 to 320 ms. AATP prescribed the components and delivery of successive ATP sequences in real time, using the same settings for all patients. ICD datalogs were uploaded every ≈3 months, at unscheduled visits, exit, and death. Episodes and adverse events were adjudicated by separate committees. Results were adjusted (generalized estimating equations) for multiple episodes. AATP was downloaded into the ICDs of 144 patients (121 men), aged 67.4±11.9 years, left ventricular ejection fraction 33.1±13.6% (n=137), and treated 1626 episodes in 49 patients during 14.5±5.1 months of follow-up. Datalogs permitted adjudication of 702 episodes, including 669 sustained monomorphic VT, 20 polymorphic VT, 10 supraventricular tachycardia, and 3 malsensing episodes. AATP terminated 39 of 69 (59% adjusted) sustained monomorphic VT in the fast VT zone, 509 of 590 (85% adjusted) in the VT zone, and 6 of 10 in the ventricular fibrillation zone. No supraventricular tachycardias converted to VT or ventricular fibrillation. No anomalous AATP behavior was observed.
Conclusions:
The new AATP algorithm safely generated ATP sequences and controlled therapy progression in all zones without need for individualized programing.
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Affiliation(s)
- Raymond Yee
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - John D. Fisher
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Ulrika Birgersdotter-Green
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Timothy W. Smith
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - David N. Kenigsberg
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Robert Canby
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Troy Jackson
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Robert Taepke
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
| | - Paul DeGroot
- From the Department of Medicine, Division of Cardiology, Western University, London, ON, Canada (R.Y.); Department of Medicine, Montefiore-Einstein Center for Cardiovascular Disease, Montefiore Medical Center, Bronx, NY (J.D.F.); Department of Medicine, Division of Cardiology, University of California, San Diego, La Jolla (U.B.-G.); Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (T.W.S.); Department of Medicine, Division of Cardiology,
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De Maria E, Giacopelli D, Borghi A, Modonesi L, Cappelli S. Antitachycardia pacing programming in implantable cardioverter defibrillator: A systematic review. World J Cardiol 2017; 9:429-436. [PMID: 28603590 PMCID: PMC5442411 DOI: 10.4330/wjc.v9.i5.429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient’s quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias (188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation (VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.
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13
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Prognostic Significance of Nonsustained Ventricular Tachycardia Episodes Occurring Early After Implantable Cardioverter-Defibrillator Implantation Among Patients With Left Ventricular Dysfunction. Am J Cardiol 2016; 118:1503-1510. [PMID: 27634031 DOI: 10.1016/j.amjcard.2016.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 11/23/2022]
Abstract
Nonsustained ventricular tachycardias (NSVTs) are frequently observed in patients with left ventricular (LV) dysfunction. The prognostic implications of such NSVTs are conflicting. Our objective was to determine the relation between the burden of NSVT occurring early (within the first 6 months after ICD implant) and prognosis among ICD patients with LV dysfunction. We followed 416 ICD patients (age: 65 ± 11 years; LV ejection fraction: 30 ± 8; ischemic origin: 62%; primary prevention: 63%) with LV dysfunction for 41 ± 27 months. ICD programming was standardized. NSVT was defined as any VT of ≥5 beats at ≥150 beats/min which did not meet the detection criteria occurring within the first 6 months after ICD implant. A total of 250 patients (60%) presented at least one NSVT (median = 2; interquartile range 0 to 7). We classified the patients into 3 groups according to the number of NSVTs: no NSVT (n = 166); 1 to 5 NSVTs (n = 130); and >5 NSVTs (n = 120). The incidence of cardiac mortality (7.2% vs 17.7% vs 31.7%; p = 0.003), hospitalizations for heart failure (10.6% vs 24.4% vs 44.7%; p <0.001), and appropriate shock (15.7% vs 24.8% vs 43.8%; p <0.001) increased significantly with the number of NSVTs. By multivariate analysis, >5 NSVTs were found to be an independent predictor of cardiac mortality (hazard ratio [HR] 1.75; p = 0.03), hospitalization due to heart failure (HR 1.72; p = 0.001), and appropriate shock (HR 1.89; p <0.001) but not of inappropriate therapy (HR 0.9; p = 0.6). In conclusion, among ICD patients with LV dysfunction, NSVT episodes occurring in the first 6 months after implant are independently associated with a poor prognosis. Subjects with >5 NSVTs are at the highest risk.
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Arenal A, Proclemer A, Kloppe A, Lunati M, Martìnez Ferrer JB, Hersi A, Gulaj M, Wijffels MCEF, Santi E, Manotta L, Mangoni L, Gasparini M. Different impact of long-detection interval and anti-tachycardia pacing in reducing unnecessary shocks: data from the ADVANCE III trial. Europace 2016; 18:1719-1725. [PMID: 27485577 PMCID: PMC5408998 DOI: 10.1093/europace/euw032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/02/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS A long-detection interval (LDI) (30/40 intervals) has been proved to be superior to a standard-detection interval (SDI) (18/24 intervals) in terms of reducing unnecessary implantable cardioverter defibrillator (ICD) therapies. To better evaluate the different impact of LDI and anti-tachycardia pacing (ATP) on reducing painful shocks, we assessed all treated episodes in the ADVANCE III trial. METHODS AND RESULTS A total of 452 fast (200 ms < cycle length ≤ 320 ms) arrhythmic episodes were recorded: 284 in 138 patients in the SDI arm and 168 in 82 patients in the LDI arm (106/452 inappropriate detections). A total of 346 fast ventricular tachycardias (FVT) were detected in 169 patients: 208 in 105 patients with SDI and 138 in 64 patients with LDI. Setting LDI determined a significant reduction in appropriate but unnecessary therapies [208 in SDI vs. 138 in LDI; incidence rate ratio (IRR): 0.61 (95% CI 0.45-0.83), P = 0.002]. Anti-tachycardia pacing determined another 52% reduction in unnecessary shocks [208 in SDI with hypothetical shock-only programming vs. 66 in LDI with ATP; IRR: 0.37 (95% CI 0.25-0.53, P < 0.001)]. The efficacy of ATP in terminating FVT was 63% in SDI and 52% in LDI (P = 0.022). No difference in the safety profile (acceleration/degeneration and death/cardiovascular hospitalizations) was observed between the two groups. CONCLUSION The combination of LDI and ATP during charging is extremely effective and significantly reduces appropriate but unnecessary therapies. The use of LDI alone yielded a 39% reduction in appropriate but unnecessary therapies; ATP on top of LDI determined another 52% reduction in unnecessary shocks. The strategy of associating ATP and LDI could be considered in the majority of ICD recipients.
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Affiliation(s)
- Angel Arenal
- Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
| | - Axel Kloppe
- Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität-Bochum, Bochum, Germany
| | - Maurizio Lunati
- Azienda Ospedaliera Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3-20162 Milano, Italy
| | | | - Ahmad Hersi
- College of Medicine, King Saud University, 11472 Riyadh, Saudi Arabia
| | | | | | - Elisabetta Santi
- MEDTRONIC Clinical Research Center, Via Aurelia 475/477-00165, Roma, Italy
| | - Laura Manotta
- MEDTRONIC Clinical Research Center, Via Varesina, 162-20156 Milano, Italy
| | - Lorenza Mangoni
- MEDTRONIC Clinical Research Center, Via Aurelia 475/477-00165, Roma, Italy
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The precise timing of tachycardia entrainment is determined by the postpacing interval, the tachycardia cycle length, and the pacing rate: Theoretical insights and practical applications. Heart Rhythm 2015; 13:695-703. [PMID: 26611239 DOI: 10.1016/j.hrthm.2015.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous observations have reported that the number of pacing stimuli required to entrain a tachycardia varies on the basis of arrhythmia type and location, but a quantitative formulation of the number needed to entrain (NNE) that unifies these observations has not been characterized. OBJECTIVE We sought to investigate the relationship between the number of pacing stimulations, the tachycardia cycle length (TCL), the overdrive pacing cycle length (PCL), and the postpacing interval (PPI) to accurately estimate the timing of tachycardia entrainment. METHODS First, we detailed a mathematical derivation unifying electrophysiological parameters with empirical confirmation in 2 patients undergoing catheter ablation of typical atrial flutter. Second, we validated our formula in 44 patients who underwent various catheter ablation procedures. For accuracy, we corrected for rate-related changes in conduction velocity. RESULTS We derived the equations NNE = |(PPI - TCL)/(TCL - PCL)| + 1 and Tachycardia advancement = (NNE - 1) × (TCL - PCL) - (PPI - TCL), which state that the NNE and the amount of tachycardia advancement on the first resetting stimulation are determined using regularly measured intracardiac parameters. In the retrospective cohort, the observed PPI - TCL highly correlated with the predicted PPI - TCL (mean difference 5.8 ms; r = 0.97; P < .001), calculated as PPI - TCL = (NNE - 1) × (TCL - PCL) - tachycardia advancement. CONCLUSION The number of pacing stimulations required to entrain a reentrant tachycardia is predictable at any PCL after correcting for cycle length-dependent changes in conduction velocity. This relationship unifies established empirically derived diagnostic and mapping criteria for supraventricular tachycardia and ventricular tachycardia. This relationship may help elucidate when antitachycardia pacing episodes are ineffective or proarrhythmic and could potentially serve as a theoretical basis to customize antitachycardia pacing settings for improved safety and effectiveness.
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16
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Jiménez-Candil J, Hernández J, Martín A, Moríñigo J, Perdiguero P, Bravo L, Ruiz S, Sánchez PL. Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms. J Interv Card Electrophysiol 2015; 44:187-95. [DOI: 10.1007/s10840-015-0050-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
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Anguera I, Dallaglio P, Martínez-Ferrer J, Rodríguez A, Alzueta J, Pérez-Villacastín J, Porres JM, Viñolas X, Fontenla A, Fernández-Lozano I, García-Alberola A, Sabaté X. Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study. J Cardiovasc Electrophysiol 2015; 26:774-82. [PMID: 25916814 DOI: 10.1111/jce.12699] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst. METHODS AND RESULTS We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness. CONCLUSION This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.
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Affiliation(s)
- Ignasi Anguera
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Paolo Dallaglio
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | | | - Aníbal Rodríguez
- Cardiology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Javier Alzueta
- Cardiology Department, Hospital Vírgen de la Victoria, Málaga, Spain
| | | | - José Manuel Porres
- Cardiology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | - Xavier Viñolas
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Adolfo Fontenla
- Cardiology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Xavier Sabaté
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
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Cantillon DJ, Wilkoff BL. Antitachycardia pacing for reduction of implantable cardioverter-defibrillator shocks. Heart Rhythm 2015; 12:1370-5. [PMID: 25708880 DOI: 10.1016/j.hrthm.2015.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Indexed: 12/11/2022]
Abstract
Antitachycardia pacing (ATP) strategies represent safe, effective, and painless therapy for ventricular tachyarrhythmias, with a large body of clinical evidence supporting their routine use in both primary and secondary implantable cardioverter-defibrillator recipients. This article details the evidence supporting the use of standardized and validated ATP strategies for primary prevention patients and the conceptual framework to design effective ATP strategy for secondary prevention patients.
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Affiliation(s)
- Daniel J Cantillon
- Cleveland Clinic, Heart and Vascular Institute, Cardiac Electrophysiology and Pacing, Cleveland, Ohio.
| | - Bruce L Wilkoff
- Cleveland Clinic, Heart and Vascular Institute, Cardiac Electrophysiology and Pacing, Cleveland, Ohio
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Jiménez-Candil J, Moríñigo JL, Hernández J, Martín A, Durán O, Carlos Rama J, Ledesma C, Sánchez PL. Fragmentation of the paced QRS complex: a marker of antitachycardia pacing effectiveness among ICD patients. J Cardiovasc Electrophysiol 2014; 25:1100-8. [PMID: 24816219 DOI: 10.1111/jce.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/25/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The presence of notches in the paced QRS complex (P-QRS) from the right ventricular apex (RVA) reflects delays in the activation of the left ventricle and may therefore be associated with longer times of stimulus conduction. Our objective was to determine prospectively the relationship between the duration of a notch ≥0.1 mV in the P-QRS (DN) and the effectiveness of antitachycardia pacing (ATP). METHODS AND RESULTS We followed 286 implantable cardioverter-defibrillator (ICD) patients with left ventricular dysfunction (pacing site: RVA) for 41 ± 27 months. ICD programming was standardized. P-QRS (100 bpm) was obtained at implant (50 mm/s). A total of 955 monomorphic ventricular tachycardias (VTs) with a cycle length of 335 ± 32 milliseconds occurred consecutively in 108 patients. ATP was successful in 84% of VTs. DN correlated with the probability of ineffective ATP (C = 0.67; P < 0.001), the cutoff point with the best sensitivity and specificity being 50 milliseconds. The adjusted mean ATP effectiveness per patient was 76% (95% CI: 72-85). Patients with a DN ≥ 50 milliseconds had a lower ATP efficiency: 67% (56-77) versus 92% (87-97) and a higher proportion of VTs terminated with shocks (SH): 31% (21-42) versus 8% (2-14); P < 0.001 for both. Although the occurrence of VT was similar (41% vs. 40%), the incidence of VT-related SH was higher in patients with a DN ≥ 50 (25% vs. 14%; P = 0.01) in the overall study population (n = 286). CONCLUSIONS When ATP is applied to the RVA, a DN ≥ 50 milliseconds is associated with a lower ATP effectiveness and a higher risk of SH due to VT.
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20
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TUAN TACHUAN, LO MENTZUNG, LIN YENNJIANG, HSIEH WANHSIN, LIN CHEN, HUANG NORDENE, LO LIWEI, CHAO TZEFAN, LIAO JONAN, HSIEH YUCHENG, WU TSUJUEY, CHEN SHIHANN. The Use of Signal Analyses of Ventricular Tachycardia Electrograms to Predict the Response of Antitachycardia Pacing in Patients with Implantable Cardioverter-Defibrillators. J Cardiovasc Electrophysiol 2014; 25:411-417. [DOI: 10.1111/jce.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- TA-CHUAN TUAN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital; Taipei Taiwan
| | - MEN-TZUNG LO
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - YENN-JIANG LIN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - WAN-HSIN HSIEH
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Medical Biodynamics Program; Division of Sleep Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - CHEN LIN
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Palo Alto California USA
| | - NORDEN E. HUANG
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - LI-WEI LO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - TZE-FAN CHAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - JO-NAN LIAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - YU-CHENG HSIEH
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - TSU-JUEY WU
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - SHIH-ANN CHEN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
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ANGUERA IGNASI, DALLAGLIO PAOLO, SABATÉ XAVIER, NUÑEZ ELAINE, GRACIDA MONTSERRAT, DI MARCO ANDREA, SUGRAÑES GEMA, CEQUIER ANGEL. The Benefit of a Second Burst Antitachycardia Sequence for Fast Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:486-94. [DOI: 10.1111/pace.12298] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/29/2013] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
Affiliation(s)
- IGNASI ANGUERA
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - PAOLO DALLAGLIO
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - XAVIER SABATÉ
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - ELAINE NUÑEZ
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - MONTSERRAT GRACIDA
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - ANDREA DI MARCO
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - GEMA SUGRAÑES
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
| | - ANGEL CEQUIER
- Arrhythmia and Electrophysiology Unit, Heart Disease Institute, [Bellvitge Biomedical Research Institute] IDIBELL, Bellvitge University Hospital-ICS; University of Barcelona; L'Hospitalet de Llobregat; Barcelona Spain
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JIMÉNEZ-CANDIL JAVIER, ANGUERA IGNASI, LEDESMA CLAUDIO, FERNÁNDEZ-PORTALES JAVIER, MORÍÑIGO JOSÉLUIS, DALLAGLIO PAOLO, MARTÍN ANA, CANO TERESA, HERNÁNDEZ JESÚS, SABATÉ XAVIER, MARTÍN-LUENGO CÁNDIDO. Morphology of Far-Field Electrograms and Antitachycardia Pacing Effectiveness Among Fast Ventricular Tachycardias Occurring in ICD Patients: A Multicenter Study. J Cardiovasc Electrophysiol 2013; 24:1375-82. [DOI: 10.1111/jce.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - IGNASI ANGUERA
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
| | - CLAUDIO LEDESMA
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | | | | | - PAOLO DALLAGLIO
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
| | - ANA MARTÍN
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | - TERESA CANO
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | | | - XAVIER SABATÉ
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
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de Bie MK, Thijssen J, van Rees JB, Putter H, van der Velde ET, Schalij MJ, van Erven L. Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice. Heart 2013; 99:1018-23. [PMID: 23704324 DOI: 10.1136/heartjnl-2012-303349] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the proportion of current implantable cardioverter defibrillator (ICD) recipients who would be suitable for a subcutaneous lead ICD (S-ICD). DESIGN A retrospective cohort study. SETTING Tertiary care facility in the Netherlands. PATIENTS All patients who received a single- or dual-chamber ICD in the Leiden University Medical Center between 2002 and 2011. Patients with a pre-existent indication for cardiac pacing were excluded. MAIN OUTCOME MEASURE Suitability for an S-ICD defined as not reaching one of the following endpoints during follow-up: (1) an atrial and/or right ventricular pacing indication, (2) successful antitachycardia pacing without a subsequent shock or (3) an upgrade to a CRT-D device. RESULTS During a median follow-up of 3.4 years (IQR 1.7-5.7 years), 463 patients (34% of the total population of 1345 patients) reached an endpoint. The cumulative incidence of ICD recipients suitable for an initial S-ICD implantation was 55.5% (95% CI 52.0% to 59.0%) after 5 years. Significant predictors for the unsuitability of an S-ICD were: secondary prevention, severe heart failure and prolonged QRS duration. CONCLUSIONS After 5 years of follow-up, approximately 55% of the patients would have been suitable for an S-ICD implantation. Several baseline clinical characteristics were demonstrated to be useful in the selection of patients suitable for an S-ICD implantation.
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MESH Headings
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Follow-Up Studies
- Humans
- Incidence
- Male
- Middle Aged
- Netherlands/epidemiology
- Retrospective Studies
- Risk Factors
- Secondary Prevention/methods
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
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Affiliation(s)
- Mihály K de Bie
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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24
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Jiménez-Candil J, Hernández J, Martín A, Moríñigo J, López R, Ledesma C, Martín-Luengo C. Influence of cycle length variations on antitachycardia pacing effectiveness among ICD patients. Heart Rhythm 2013; 10:207-13. [DOI: 10.1016/j.hrthm.2012.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Indexed: 10/27/2022]
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Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand. Heart Lung Circ 2012; 21:765-77. [DOI: 10.1016/j.hlc.2012.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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A novel low-energy electrotherapy that terminates ventricular tachycardia with lower energy than a biphasic shock when antitachycardia pacing fails. J Am Coll Cardiol 2012; 60:2393-8. [PMID: 23141483 DOI: 10.1016/j.jacc.2012.08.1001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/31/2012] [Accepted: 08/06/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The authors sought to develop a low-energy electrotherapy that terminates ventricular tachycardia (VT) when antitachycardia pacing (ATP) fails. BACKGROUND High-energy implantable cardioverter-defibrillator (ICD) shocks are associated with device failure, significant morbidity, and increased mortality. A low-energy alternative to ICD shocks is desirable. METHODS Myocardial infarction was created in 25 dogs. Sustained, monomorphic VT was induced by programmed stimulation. Defibrillation electrodes were placed in the right ventricular apex, and coronary sinus and left ventricular epicardium. If ATP failed to terminate sustained VT, the defibrillation thresholds (DFTs) of standard versus experimental electrotherapies were measured. RESULTS Sustained VT ranged from 276 to 438 beats/min (mean 339 beats/min). The right ventricular-coronary sinus shock vector had lower impedance than the right ventricular-left ventricular patch (54.4 ± 18.1 Ω versus 109.8 ± 16.9 Ω; p < 0.001). A single shock required between 0.3 ± 0.2 J to 5.9 ± 2.5 J (mean 2.64 ± 3.22 J; p = 0.008) to terminate VT, and varied depending upon the phase of the VT cycle in which it was delivered. By contrast, multiple shocks delivered within 1 VT cycle length were not phase dependent and achieved lower DFT compared with a single shock (0.13 ± 0.09 J for 3 shocks, 0.08 ± 0.04 J for 5 shocks, and 0.09 ± 0.07 J for 7 shocks; p < 0.001). Finally, a multistage electrotherapy (MSE) achieved significantly lower DFT compared with a single biphasic shock (0.03 ± 0.05 J versus 2.37 ± 1.20 J; respectively, p < 0.001). At a peak shock amplitude of 20 V, MSE achieved 91.3% of terminations versus 10.5% for a biphasic shock (p < 0.001). CONCLUSIONS MSE achieved a major reduction in DFT compared with a single biphasic shock for ATP-refractory monomorphic VT, and represents a novel electrotherapy to reduce high-energy ICD shocks.
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Němec J. Antitachycardia pacing or shock therapy—trick or treat? Heart Rhythm 2012; 9:359-60. [DOI: 10.1016/j.hrthm.2011.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Indexed: 11/25/2022]
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Venkataraman G, Strickberger SA. The role of ventricular tachycardia ablation in the reduction of implantable defibrillator shocks. Heart Fail Clin 2011; 7:207-13, viii. [PMID: 21439499 DOI: 10.1016/j.hfc.2010.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Frequent shocks from an implantable defibrillator (ICD) can have adverse cardiac affects and lead to increased pain, anxiety, and a decreased quality of life. Pharmacologic attempts and ICD reprogramming strategies aimed at reducing ICD shocks have modest results, with frequent discontinuation of medicines because of side effects. Ventricular tachycardia (VT) ablation is recommended in the treatment of patients with frequent ICD shocks caused by VT. VT ablation may also be considered in patients with an initial ICD shock and as prophylactic treatment in patients with a history of sustained VT who are undergoing ICD implant.
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Affiliation(s)
- Ganesh Venkataraman
- Washington Electrophysiology, and Cardiovascular Research Institute, Washington Hospital Center, 106 Irving Street, NW, South #204, Washington, DC 20010-2975, USA.
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Khairy P, Mansour F. Implantable cardioverter-defibrillators in congenital heart disease: 10 programming tips. Heart Rhythm 2011; 8:480-3. [PMID: 21056119 DOI: 10.1016/j.hrthm.2010.10.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
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MANSOUR FADI, KHAIRY PAUL. Programming ICDs in the Modern Era beyond Out-of-the Box Settings. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:506-20. [DOI: 10.1111/j.1540-8159.2011.03037.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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MANUCHEHRY AMIN, AGUSALA KARTIK, MONTEVECCHI MAURO, KADISH ALAN, PASSMAN ROD. Ventricular Tachyarrhythmias in Patients Receiving an Implantable Cardioverter-Defibrillator for Primary versus Secondary Prophylaxis Indications. Pacing Clin Electrophysiol 2011; 34:571-6. [DOI: 10.1111/j.1540-8159.2010.03004.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jimenez-Candil J, Hernandez J, Martin A, Ruiz-Olgado M, Herrero J, Ledesma C, Morinigo J, Martin-Luengo C. Influence of beta-blocker therapy on antitachycardia pacing effectiveness for monomorphic ventricular tachycardias occurring in implantable cardioverter-defibrillator patients: a dose-dependent effect. Europace 2010; 12:1231-8. [DOI: 10.1093/europace/euq164] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prospective multicenter randomized trial of fast ventricular tachycardia termination by prolonged versus conventional anti-tachyarrhythmia burst pacing in implantable cardioverter-defibrillator patients-Atp DeliVery for pAiNless ICD thErapy (ADVANCE-D) Trial results. J Interv Card Electrophysiol 2010; 27:127-35. [PMID: 20087760 PMCID: PMC2836470 DOI: 10.1007/s10840-009-9454-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 10/18/2009] [Indexed: 01/30/2023]
Abstract
Purpose The purpose of the trial was to quantify and compare the efficacy of two different sequences of burst anti-tachycardia pacing (ATP) strategies for the termination of fast ventricular tachycardia. Methods The trial was prospective, multicenter, parallel and randomized, enrolling patients with an indication for implantable cardioverter-defibrillator implantation. Results From February 2004, 925 patients were randomized and followed-up for 12 months. Eight pulses ATP terminated 64% of episodes vs. 70% in the 15-pulse group (p = 0.504). Fifteen pulses proved significantly better in patients without a previous history of heart failure (p = 0.014) and in patients with LVEF ≥ 40% (p = 0.016). No significant differences between groups were observed with regard to syncope/near-syncope occurrence. Conclusion In the general population, 15-pulse ATP is as effective and safe as eight-pulse ATP. The efficacy of ATP on fast ventricular arrhythmias confirmed once more the striking importance of careful device programming in order to reduce painful shocks.
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JIMÉNEZ-CANDIL JAVIER, RUIZ MARÍA, HERRERO JESÚS, LEÓN VÍCTOR, MARTÍN ANA, MORIÑIGO JOSÉ, LEDESMA CLAUDIO, MARTÍN-LUENGO CÁNDIDO. Relationship between the Duration of the Basal QRS Complex and Electrical Therapies for Ventricular Tachycardias among ICD Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:596-604. [DOI: 10.1111/j.1540-8159.2009.02648.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gupta A, Al-Ahmad A, Wang PJ. Subcutaneous Implantable Cardioverter-Defibrillator Technology. Card Electrophysiol Clin 2009; 1:147-154. [PMID: 28770781 DOI: 10.1016/j.ccep.2009.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The advent of subcutaneous implantable cardioverter-defibrillator (ICD) systems represents a paradigm shift for the detection and therapy of ventricular tachyarrhythmias. Despite advances in transvenous lead technology, problems remain that notably include requirement for technical expertise; periprocedural complications during implantation and explantation; and long-term lead failure. Although subcutaneous ICD systems may mitigate some of these risks, they provide new shortcomings, such as inability to provide pacing therapy for bradyarrhythmias, ventricular tachyarrhythmias, and cardiac resynchronization. Ongoing clinical evaluation and development are required before the role of subcutaneous ICDs as an adjunctive or primary therapy can be defined. This article examines studies investigating the subcutaneous ICD and discusses its possible advantages and disadvantages as compared with current transvenous ICD systems.
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Affiliation(s)
- Anurag Gupta
- Department of Internal Medicine, Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive, Room H2146, Stanford, CA 94305-5233, USA
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Multiple monophasic shocks improve electrotherapy of ventricular tachycardia in a rabbit model of chronic infarction. Heart Rhythm 2009; 6:1020-7. [PMID: 19560090 DOI: 10.1016/j.hrthm.2009.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 03/04/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND We previously showed that the cardioversion threshold (CVT) for ventricular tachycardia (VT) is phase dependent when a single monophasic shock (1MP) is used. OBJECTIVE The purpose of this study was to extend these findings to a biphasic shock (1BP) and to compare the efficacy of phase-independent multiple monophasic (5MP) and biphasic shocks (5BP). METHODS Panoramic optical mapping with blebbistatin (5 microM) was performed in postmyocardial infarction rabbit hearts (n = 8). Flecainide (1.64 +/- 0.68 microM) was administered to promote sustained arrhythmias. 5MP and 5BP were applied within one VT cycle length (CL). Results were compared to 1BP and antitachycardia pacing. RESULTS We observed monomorphic VT with CL = 149.6 +/- 18.0 ms. Similar to 1MP, CVTs of 1BP were found to be phase dependent, and the maximum versus minimum CVT was 8.6 +/- 1.7 V/cm versus 3.7 +/- 1.9 V/cm, respectively (P = .0013). Efficacy of 5MP was higher than that of 1BP and 5BP. CVT was 3.2 +/- 1.4 V/cm for 5MP versus 5.3 +/- 1.9 V/cm for 5BP (P = .00027). 5MP versus averaged 1BP CVT was 3.6 +/- 2.1 V/cm versus. 6.8 +/- 1.5 V/cm, respectively (P = .00024). Antitachycardia pacing was found to be completely ineffective in this model. CONCLUSION Maintenance of shock-induced virtual electrode polarization by multiple monophasic shocks over a VT cycle is responsible for unpinning of reentry leading to self-termination. Elimination of virtual electrode polarization by shock polarity reversal during multiple biphasic shocks proved ineffective. A significant reduction in CVT can be achieved by applying multiple monophasic shocks within one VT CL or one single shock at the proper coupling interval.
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SIVAGANGABALAN GOPAL, ESHOO SUZANNE, EIPPER VICKIE, THIAGALINGAM ARAVINDA, KOVOOR PRAMESH. Discriminatory Therapy for Very Fast Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1095-9. [DOI: 10.1111/j.1540-8159.2008.01147.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lunati M, Defaye P, Mermi J, Garcia-Alberola A, Merino JL, Arenal A, Cappato R, Navarro X, Passardi M, Santini M. Improvement of quality of life by means of antitachy pacing: from PainFREE to the ADVANCE-D Trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 29 Suppl 2:S35-9. [PMID: 17169131 DOI: 10.1111/j.1540-8159.2006.00488.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICD) can terminate ventricular tachyarrhythmias with shocks (painful) or antitachycardia pacing (painless). According to the results of the Pacing Fast VT Reduces Shock ThErapies Trials, antitachycardia pacing (ATP) can avoid painful shocks and also increase device longevity. The purpose of the ADVANCE-D (Atp DeliVery for PAiNless ICD ThErapy) study is to determine the most appropriate ventricular tachycardia (VT) therapy, so as to optimize painless therapy for life-threatening arrhythmias. METHODS AND RESULTS The ADVANCE-D is a prospective, multicenter, parallel, two-arm randomized study designed to evaluate the efficacy of two different sequences of ATP therapies (burst 15 pulses, 88%, vs burst 8 pulses, 88%), during an episode of spontaneous arrhythmia classified as fast VT (FVT) in patients with a Class I or IIA indication for ICD implantation (single and dual chamber devices). The primary endpoint is to compare the efficacy of two ATP therapies for FVT episodes. The study will enroll a minimum of 900 patients within 2 years, followed-up for 12 months. The investigation is expected to be completed in 2007. CONCLUSIONS The ADVANCE-D trial is the first large randomized clinical investigation aimed to evaluate optimal programming and efficacy of ATP.
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Affiliation(s)
- Maurizio Lunati
- Dipartimento di Cardiologia "De Gasperis," AO Niguarda Cà Granda, Milano, Italy.
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Arenal A, Ortiz M, Peinado R, Merino JL, Quesada A, Atienza F, Alberola AG, Ormaetxe J, Castellanos E, Rodriguez JC, Pérez N, García J, Boluda L, del Prado M, Artés A. Differentiation of ventricular and supraventricular tachycardias based on the analysis of the first postpacing interval after sequential anti-tachycardia pacing in implantable cardioverter-defibrillator patients. Heart Rhythm 2007; 4:316-22. [PMID: 17341396 DOI: 10.1016/j.hrthm.2006.10.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Current discrimination algorithms do not completely avoid inappropriate tachycardia detection. OBJECTIVES This study analyzes the discrimination capability of the changes of the first postpacing interval (FPPI) after successive bursts of anti-tachycardia pacing (ATP) trains in implantable cardioverter-defibrillator (ICD)-recorded tachycardias. METHODS We included 50 ICD patients in this prospective study. We hypothesized that the FPPI variability (FPPIV) when comparing bursts with different numbers of beats would be shorter in ventricular tachycardias (VTs) compared with supraventricular tachycardias (SVTs). The ATP (5-10 pulses, 91% of tachycardia cycle length) was programmed for tachycardias >240 ms. RESULTS Anti-tachycardia pacing was delivered during 37 sinus tachycardias (STs) in an exercise test, 96 induced VTs in an electrophysiological study, and 198 spontaneous episodes (144 VTs and 54 SVTs). The FPPI remained stable after all ATP bursts in VT but changed continuously in SVT; when comparing bursts of 5 and 10 pulses, the FPPIV was shorter in VT (34 +/- 65 vs.138 +/- 69, P<.0001, in all T and 12 +/- 20 vs. 138 +/- 69, P<.0001, in T>or=320 ms) than in SVT. In T>or=320 ms an FPPIV<or=50 ms between bursts of 5 and 10 pulses classified correctly 100% of VTs and 90% of SVTs. Anti-tachycardia pacing terminated 66% of induced VTs, 60% of spontaneous VTs, and 20% of spontaneous SVTs and induced no VT during spontaneous or exercise induced SVT. Five induced and two spontaneous VT episodes were accelerated. CONCLUSIONS Analysis of FPPIV after ATP discriminates ICD-detected T. Successive bursts (of ATP) trains at 91% of tachycardia cycle length are safe, despite being delivered before rhythm classification.
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Affiliation(s)
- Angel Arenal
- Laboratorio de Electrofisiología, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Sauer WH, Callans DJ. The Implantable Cardioverter-Defibrillator. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Saba S, Baker L, Ganz L, Barrington W, Jain S, Ngwu O, Christensen J, Brown M. Simultaneous Atrial and Ventricular Anti-Tachycardia Pacing as a Novel Method of Rhythm Discrimination. J Cardiovasc Electrophysiol 2006; 17:695-701. [PMID: 16836661 DOI: 10.1111/j.1540-8167.2006.00471.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate a new discrimination algorithm for supraventricular (SVT) and ventricular (VT) tachycardias, based on the response to simultaneous (A+V) atrial (A) and ventricular (V) anti-tachycardia pacing (ATP). METHODS Patients undergoing electrophysiological testing or dual-chamber implantable cardioverter-defibrillator (ICD) implantation were enrolled (N = 32) and underwent A+V ATP through a Marquis ICD with investigational software. If persisting after ATP, the rhythm was classified as VT if the first electrical event was sensed on the V channel and as an SVT otherwise. RESULTS Arrhythmia sequences (N = 275; 53 VT; 222 SVT) were analyzed in 26 patients (age = 51 +/- 17 years, 13 men, LVEF = 0.49 +/- 0.14). In response to A+V ATP, 55% of SVT versus 41% of VT episodes were terminated (P = NS). Termination of VT but not of SVT was more likely with faster (50% at ATP/arrhythmia cycle length (CL) = 0.81 vs 8% at ATP/arrhythmia CL = 0.88, P = 0.02) but not with longer ATP bursts (P = NS). Of the 115 arrhythmias that persisted after A+V ATP, the algorithm correctly classified 24 of 24 VT (GEE-adjusted sensitivity = 100%) and 85 of 91 SVT (GEE-adjusted specificity = 93%). Proarrhythmia was noted after two A+V ATP, in the form of atrial fibrillation induction and VT acceleration. CONCLUSIONS We describe a new algorithm that can discriminate between SVT and VT with a high sensitivity and specificity. This form of ATP can terminate 55% of SVT sequences. The performance of this new algorithm merits further testing in a large population of dual-chamber ICD patients.
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Affiliation(s)
- Samir Saba
- University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Grimm W, Plachta E, Maisch B. Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients with Prophylactic Cardioverter-Defibrillator Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:759-64. [PMID: 16884513 DOI: 10.1111/j.1540-8159.2006.00431.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Antitachycardia pacing (ATP) has not routinely been used in patients who received implantable cardioverter defibrillators (ICDs) for primary prevention of sudden death. This study investigated the efficacy of empirical ATP to terminate rapid ventricular tachycardia (VT) in heart failure patients with prophylactic ICD therapy. METHODS AND RESULTS Ninety-three patients with a mean left ventricular ejection fraction of 22 +/- 7% (range: 9-35%) due to nonischemic or ischemic cardiomyopathy received prophylactic ICDs with empiric ATP. At least 2 ATP sequences with 6-pulse burst pacing trains at 81% of VT cycle length (CL) were programmed in one or two VT zones for CL below 335 +/- 23 ms and above 253 +/- 18 ms. Ventricular flutter and fibrillation (VF) with CL below 253 +/- 18 ms were treated in a separate VF zone with ICD shocks without preceding ATP attempts. During 38 +/- 27 months follow-up, 339 spontaneous ventricular tachyarrhythmias occurred in 36 of 93 study patients (39%). A total of 232 VT episodes, mean CL 293 +/- 22 ms, triggered ATP in 25 of 36 patients with ICD interventions (69%). ATP terminated 199 of 232 VT episodes (86%) with a mean CL of 294 +/- 23 ms in 23 of 25 patients (88%) who received ATP therapy. ATP failed to terminate or accelerated 33 of 232 VT episodes (14%) with a mean CL of 287 +/- 19 ms in 12 of 25 patients (48%) who received ATP therapy. CONCLUSIONS Painfree termination of rapid VT with empirical ATP is common in heart failure patients with prophylactic ICD therapy. The occasional inability of empiric ATP to terminate rapid VT in almost 50% of patients who receive ATP for rapid VT warrants restrictive ICD programming with regard to the number of ATP attempts in order to avoid syncope before VT termination occurs.
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Affiliation(s)
- Wolfram Grimm
- Department of Cardiology, Hospital of the Philipps-University of Marburg, Marburg, Germany.
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Mark Estes NA. Discrimination When Dual-Chamber Termination Fails: A New Paradigm for ICDs? J Cardiovasc Electrophysiol 2006; 17:702-4. [PMID: 16836662 DOI: 10.1111/j.1540-8167.2006.00493.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ripplinger CM, Krinsky VI, Nikolski VP, Efimov IR. Mechanisms of unpinning and termination of ventricular tachycardia. Am J Physiol Heart Circ Physiol 2006; 291:H184-92. [PMID: 16501014 DOI: 10.1152/ajpheart.01300.2005] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High-energy defibrillation shock is the only therapy for ventricular tachyarrhythmias. However, because of adverse side effects, lowering defibrillation energy is desirable. We investigated mechanisms of unpinning, destabilization, and termination of ventricular tachycardia (VT) by low-energy shocks in isolated rabbit right ventricular preparations (n = 22). Stable VT was initiated with burst pacing and was optically mapped. Monophasic "unpinning" shocks (10 ms) of different strengths were applied at various phases throughout the reentry cycle. In 8 of 22 preparations, antitachycardia pacing (ATP: 8-20 pulses, 50-105% of period, 0.8-10 mA) was also applied. Termination of reentry by ATP was achieved in only 5 of 8 preparations. Termination by unpinning occurred in all 22 preparations. Rayleigh's test showed a statistically significant unpinning phase window, during which reentry could be unpinned and subsequently terminated with E80 (magnitude at which 80% of reentries were unpinned) = 1.2 V/cm. All reentries were unpinned with field strengths < or = 2.4 V/cm. Unpinning was achieved by inducing virtual electrode polarization and secondary sources of excitation at the core of reentry. Optical mapping revealed the mechanisms of phase-dependent unpinning of reentry. These results suggest that a 20-fold reduction in energy could be achieved compared with conventional high-energy defibrillation and that the unpinning method may be more effective than ATP for terminating stable, pinned reentry in this experimental model.
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Affiliation(s)
- Crystal M Ripplinger
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
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Fernández Lozano I, Higgins S, Escudier Villa JM, Niazi I, Toquero J, Yong P, Madrid Á, Alonso Pulpón L. La eficacia de la estimulación antitaquicardia mejora tras la terapia de resincronización cardíaca. Rev Esp Cardiol 2005. [DOI: 10.1157/13079908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abello M, Merino JL, Peinado R, Gnoatto M, Arias MA, Gonzalez-Vasserot M, Sobrino JA. Syncope following cardioverter defibrillator implantation in patients with spontaneous syncopal monomorphic ventricular tachycardia. Eur Heart J 2005; 27:89-95. [PMID: 16183691 DOI: 10.1093/eurheartj/ehi500] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We sought to determine the incidence, mechanisms, and time to syncope recurrence in patients with spontaneous syncopal monomorphic ventricular tachycardia (SyMVT) treated with an implantable cardiac defibrillator (ICD). METHODS AND RESULTS Incidence and causes of syncope following ICD implantation in consecutive patients (n=26) with spontaneous SyMVT were compared with those found in consecutive patients (n=50) with spontaneous non-syncopal monomorphic ventricular tachycardia (NSyMVT). Patients with SyMVT had a higher incidence of syncope (46% patients) than those with NSyMVT (2% patients) at 31+/-21 and 34+/-23 months follow-up, respectively (hazard ratio, 0.19; 95% confidence interval, 0.04-0.42; P=0.0001). Among the former, four patients (15%) had non-arrhythmic syncope and eight patients had arrhythmic syncope (31%), which was associated with either ICD proarrhythmia (seven episodes of VT acceleration or VF degeneration by ATP or low/high-energy shocks in three patients) or spontaneous VT and VF (five episodes in five patients). Median time to the first arrhythmic syncope was 376 days. Arrhythmic syncope presented after a first non-syncopal VT recurrence in six patients (75%). CONCLUSION Syncope following ICD implantation is common in patients with SyMVT in contrast to patients with NSyMVT. Late syncope presentation supports reassessment of driving restrictions in this setting.
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Affiliation(s)
- Mauricio Abello
- Clinical Cardiac Electrophysiology Laboratory, Cardiology Division, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain
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Jiménez-Candil J, Arenal A, García-Alberola A, Ortiz M, del Castillo S, Fernández-Portales J, Sánchez-Muñoz J, Martínez-Sánchez J, González-Torrecilla E, Atienza F, Puchol A, Almendral J. Fast ventricular tachycardias in patients with implantable cardioverter-defibrillators: efficacy and safety of antitachycardia pacing. A prospective and randomized study. J Am Coll Cardiol 2005; 45:460-1. [PMID: 15680729 DOI: 10.1016/j.jacc.2004.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sweeney MO. Antitachycardia pacing for ventricular tachycardia using implantable cardioverter defibrillators:. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 27:1292-305. [PMID: 15461721 DOI: 10.1111/j.1540-8159.2004.00622.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Michael O Sweeney
- CRM Research, Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, Canby RC, Khalighi K, Machado C, Rubenstein DS, Volosin KJ. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 2004; 110:2591-6. [PMID: 15492306 DOI: 10.1161/01.cir.0000145610.64014.e4] [Citation(s) in RCA: 509] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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) >200 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 (n=313) or shock (n=321)-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 >250 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 11+/-3 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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Affiliation(s)
- Mark S Wathen
- Vanderbilt Page-Campbell Heart Institute, Vanderbilt University Medical Center, 2220 Pierce, Nashville, TN 37232, USA.
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