title: Safety and efficacy of programming a high number of antitachycardia pacing attempts for fast ventricular tachycardia: a prospective study.
abstract: OBJECTIVE
  Little is known about the optimal number of antitachycardia pacing (ATP) attempts to programme in the fast ventricular tachycardia (FVT) zone. We sought to analyse the long-term efficacy and safety of programming a high number of ATP attempts for FVTs.
  
  
  RESULTS
  All patients receiving an implantable cardioverter/defibrillator (ICD) for coronary artery disease or dilated cardiomyopathy for primary and secondary prevention between 2000 and 2009 were prospectively included. Implantable cardioverter/defibrillators were programmed to deliver 10 ATP attempts for FVT cycle lengths (CLs) of 250-300 ms (200-240 b.p.m.) before shock delivery (5 bursts, then 5 ramps; 8-10 extrastimuli at 81-88% FVT CL; minimal pacing CL 180 ms). Among 770 patients included and followed for 40.6 ± 25.6 months, 137 (17.8%) experienced a total of 1839 FVTs, 1713 of which were ATP-terminated (unadjusted efficacy = 93.1%, adjusted = 81.7%), 106 ATP-accelerated (5.8%), and 20 ATP-resistant (1.1%). The majority of FVT episodes were successfully treated by one or two attempts (98.3%). However, patient-based analysis showed that 17 (12.4%), 8 (5.8%), and 5 patients (2.1%) had at least one episode treated by three or more, four or more, and five or more ATP attempts. The benefit of this strategy was reduced after five attempts. The majority of FVT episodes was asymptomatic and diagnosed at device interrogation during follow-up: syncope and pre-syncope occurred in only 0.2 and 0.4% of episodes, respectively.
  
  
  CONCLUSIONS
  Programming a high number of ATP attempts (up to five ATP attempts) in the FVT zone is both safe and efficient and could prevent shocks in numerous ICD recipients.
authors.affiliation: CHU Nancy,  Service de Cardiologie, 54511 Vandoeuvre les Nancy,  France.
authors.forename: Raphaël P
authors.initials: RP
authors.lastname: Martins
authors.forename: Hugues
authors.initials: H
authors.lastname: Blangy
authors.forename: Lucian
authors.initials: L
authors.lastname: Muresan
authors.forename: Luc
authors.initials: L
authors.lastname: Freysz
authors.forename: Laurent
authors.initials: L
authors.lastname: Groben
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Zinzius
authors.forename: Jérôme
authors.initials: J
authors.lastname: Schwartz
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D003324:Coronary Artery Disease / Q000628:therapy; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome