The magnitude of sinus cycle length change during ventricular tachycardia is predictive of successful antitachycardia pacing.
BACKGROUND
Despite the wide use of antitachycardia pacing (ATP) in patients with implantable cardioverter defibrillators (ICDs), predictors of ATP success remain poorly understood. We hypothesize that the degree of sympathoexcitation, as measured by the sinus cycle length (SCL) shortening during ventricular tachycardia (VT), is a predictor of ATP success.


RESULTS
The charts of 462 patients with dual-chamber ICDs were reviewed. A total of 88 events in 26 patients met the inclusion criteria and were analyzed. The mean SCL during the 4 seconds preceding the VT onset (SCL-baseline), and during the 4 seconds prior to ATP delivery (SCL-VT) was measured. The percent shortening in SCL was calculated as ((SCL-baseline) - (SCL-VT))/(SCL-baseline) x 100. Patients were classified into the ATP-success and ATP-failure groups depending on the VT(s) response to ATP. Using a t-test analogue for clustered data, patients in the ATP-success group exhibited a greater shortening in SCL when compared with the ATP-Failure group (5.8% compared to 4.7%, P = 0.007). The successful ATP events displayed an average SCL shortening of 6.0% compared to 1.8% in the unsuccessful ATP events (P = 0.029). When the events were analyzed, the sensitivity and specificity of a shortening in SCL of >10% in predicting ATP success were 0.29 and 1.


CONCLUSIONS
We have shown that the SCL change during VT, a marker of the autonomic changes that accompany a tachycardia, is useful in predicting ATP success. Our findings suggest that analysis of the SCL during VT might play a role in future programming of ATP in patients with ICDs.
MacGregor
John F
JF
University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
Wasmund
Stephen L
SL
Pai
Rakesh K
RK
Abedin
Moeen
M
Akoum
Nazem
N
Segerson
Nathan M
NM
Freedman
Roger A
RA
Klein
Richard C
RC
Wall
T Scott
TS
Rawling
David A
DA
Shen
Shuying
S
Hamdan
Mohamed H
MH
D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology