title: Antitachycardia pacing reduces appropriate and inappropriate shocks in children and congenital heart disease patients.
abstract: BACKGROUND
  Antitachycardia pacing (ATP) can reduce implantable cardioverter-defibrillator shocks, but its use in children and patients with congenital heart disease (CHD) is not well described.
  
  
  OBJECTIVE
  To review the efficacy of ATP in children and patients with CHD.
  
  
  METHODS
  We reviewed implantable cardioverter-defibrillator therapies in children and patients with CHD (aged 2-52 years) at our institution. Appropriate therapies were defined as those delivered for true ventricular tachycardia (VT) or ventricular fibrillation; other therapies were defined as inappropriate.
  
  
  RESULTS
  During a median follow-up of 4 years (range 0.5-15 years), 17 of 79 patients (23%) received appropriate therapy and 14 received ATP for 100 episodes of VT. ATP was highly successful (88%) in terminating VT, and only 10 of 100 episodes required a shock. Shocks were effective in terminating VT/ventricular fibrillation in 21 of 24 episodes (87%). The outcomes of appropriate therapy were similar for ATP and shocks (success 88% vs 87%, failure 9% vs 8%, acceleration 3% vs 4% for ATP and shocks, respectively). Thirty-one patients (39%) received inappropriate therapy. Inappropriate ATP (without subsequent shocks) was delivered to 11 patients for the following: sinus tachycardia (19 episodes in 7 patients) with slowing of the rate after ATP, T-wave oversensing (2 episodes in 2 patients) with loss of oversensing after ATP, and reentrant supraventricular tachycardia (14 episodes in 2 patients) terminated with ventricular ATP.
  
  
  CONCLUSIONS
  ATP is highly efficacious for VT in children and patients with CHD. In addition to reducing appropriate shocks, inappropriate shocks due to sinus or supraventricular tachycardia can be significantly reduced with ATP.
authors: Department of Pediatrics, Vanderbilt University School of Medicine, and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232, USA.
authors: Yuvraj
authors: Y
authors: Kalra
authors: Andrew E
authors: AE
authors: Radbill
authors: James A
authors: JA
authors: Johns
authors: Frank A
authors: FA
authors: Fish
authors: Prince J
authors: PJ
authors: Kannankeril
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*