Improvement of quality of life by means of antitachy pacing: from PainFREE to the ADVANCE-D Trial.
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.


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.
Lunati
Maurizio
M
Dipartimento di Cardiologia "De Gasperis," AO Niguarda Cà Granda, Milano, Italy. maurizio.lunati@ospedaleniguarda.it
Defaye
Pascal
P
Mermi
Johann
J
Garcia-Alberola
Arcadi
A
Merino
José L
JL
Arenal
Angel
A
Cappato
Riccardo
R
Navarro
Xavier
X
Passardi
Micaela
M
Santini
Massimo
M
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000517:prevention & control*; D016896:Treatment Outcome