Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study.
BACKGROUND
An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst.


RESULTS
We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness.


CONCLUSIONS
This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.
Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain.
Ignasi
I
Anguera
Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain.
Paolo
P
Dallaglio
Cardiology Department, Hospital Universitario Araba, Vitoria, Spain.
Jose
J
Martínez-Ferrer
Cardiology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Aníbal
A
Rodríguez
Cardiology Department, Hospital Vírgen de la Victoria, Málaga, Spain.
Javier
J
Alzueta
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
Julián
J
Pérez-Villacastín
Cardiology Department, Hospital Universitario Donostia, San Sebastian, Spain.
José Manuel
JM
Porres
Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
Xavier
X
Viñolas
Cardiology Department, Hospital 12 de Octubre, Madrid, Spain.
Adolfo
A
Fontenla
Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
Ignacio
I
Fernández-Lozano
Cardiology Department, Hospital Universitario Vírgen de la Arrixaca, Murcia, Spain.
Arcadio
A
García-Alberola
Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain.
Xavier
X
Sabaté
D000200:Action Potentials; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D004556:Electric Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013030:Spain; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
CareLink monitoring system; ICD shocks; Umbrella study; antitachycardia pacing; implantable cardioverter defibrillator; ventricular tachycardia