title: BIVentricular versus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D Trial.
abstract: BACKGROUND
  This multicenter, prospective, randomized, controlled, parallel trial compares the efficacy of biventricular (BIV) versus right ventricular (RV) antitachycardia pacing (ATP) in terminating all kinds of ventricular tachycardia (VT).
  
  
  METHODS
  Five hundred twenty-six patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D) device were enrolled and randomized 1:1 to either BIV (266) or RV (260) ATP (single burst 8 pulse, 88% coupling interval) and were followed up for 12 months.
  
  
  RESULTS
  During 12 months' follow-up, 1,077 ventricular episodes in 180 patients were detected and classified: 634 true VTs divided into 69 ventricular fibrillation (VF) (11%), 202 fast ventricular tachycardia (FVT) (32%), and 363 VT (57%). A comparable first ATP efficacy (BIV 65% vs RV 68%, P = .59) was observed in FVT + VT, in VT zone (BIV 62% vs RV 71%, P = .25), and in FVT zone (BIV 71% vs RV 61%, P = .34). A trend toward lower accelerations during ATP applied to FVT was observed in the BIV group (3.5% BIV vs 10.2% RV, P = .163). No syncope/presyncope occurred during ATP for FVT in the BIV group versus 4 events (3.2%) in the RV group (P = .016). biventricular ATP was more effective in treating FVT in coronary artery disease (CAD) patients (P = .032), whereas both modalities presented similar efficacy in patients with non-CAD etiology (P = .549).
  
  
  CONCLUSIONS
  Antitachycardia pacing is effective in patients implanted with a CRT-D device. No significant differences in efficacy emerged between BIV- and RV-delivered ATP in the general population, whereas BIV ATP seems to present a safer profile in ischemic patients.
authors.affiliation: IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy. maurizio.gasparini@humanitas.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Frédéric
authors.initials: F
authors.lastname: Anselme
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: José
authors.initials: J
authors.lastname: Martínez-Ferrer
authors.forename: Tiziana
authors.initials: T
authors.lastname: De Santo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Santi
authors.forename: Jeorg O
authors.initials: JO
authors.lastname: Schwab
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome