Programming antitachycardia pacing for primary prevention in patients with implantable cardioverter defibrillators: results from the PROVE trial.
OBJECTIVE
the PROVE trial was designed to determine if antitachycardia pacing (ATP) is clinically beneficial for primary prevention in patients who have implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds).


BACKGROUND
use of ICDs and CRT-Ds reduces mortality in patients with ventricular dysfunction and mild to moderate heart failure. However, in studies of the primary prevention population, shock-only ICDs are predominantly used, without ATP programming for less painful termination of ventricular tachycardia (VT).


METHODS
we conducted a prospective, nonrandomized, multicenter study using market-released ICDs and CRT-Ds. Patients received devices programmed to deliver ATP for VT cycle lengths of 270-330 ms. Follow-up evaluation was performed at 3, 6, and 12 months. The incidence of VT and the rate of successful termination by ATP were analyzed.


RESULTS
of 830 patients in the study population (men, 73%; mean age, 67.3 ± 12 years), 32% received single-chamber ICDs, 44% dual-chamber ICDs, and 24% CRT-Ds. ATP was attempted for 112 VT episodes in 71 patients, and 103 (92%) of the VT episodes were successfully terminated. Three VT episodes were accelerated by ATP and required termination by ICD shock; 6 episodes terminated spontaneously or by ICD shock.


CONCLUSIONS
VT is common in patients without a history of this arrhythmia who have received ICDs or CRT-Ds for primary prevention indications. Programming ICDs for ATP therapy at the time of implantation could potentially terminate most VT episodes and reduce the number of painful shocks for these patients.
Saeed
Mohammad
M
Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA. hallgar@hgcardio.com
Neason
Curtis G
CG
Razavi
Mehdi
M
Chandiramani
Shanker
S
Alonso
Joseph
J
Natarajan
Senthil
S
Ip
John H
JH
Peress
Darren F
DF
Ramadas
Sumati
S
Massumi
Ali
A
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*