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Role of antitachycardia pacing in patients with third generation cardioverter defibrillators
H J Trappe1, H Klein, B Kielblock
1Department of Cardiology, University Hospital Hannover, Germany.
Insights
Antitachycardia pacing (ATP) effectively terminates ventricular tachycardia (VT) in most patients. However, this study found no single ATP mode superior to others in randomized testing, suggesting current options are comparable for VT management.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Antitachycardia pacing (ATP) is a crucial therapy for managing sustained ventricular tachycardia (VT).
- The optimal ATP mode for terminating VT remains debated among clinicians.
- Implantation of cardioverter-defibrillators (ICDs) necessitates effective ATP programming.
Purpose of the Study:
- To prospectively compare the efficacy of three distinct ATP modes in terminating VT.
- To evaluate ATP performance before and after cardioverter-defibrillator implantation.
- To determine if any tested ATP mode demonstrates superior efficacy in VT termination.
Main Methods:
- Randomized prospective testing of 65 patients undergoing ICD implantation.
- Three ATP modes (A, B, C) with varying burst pacing parameters were evaluated.
- ATP success rates were recorded during preoperative, predischarge, and follow-up periods.
Main Results:
- Overall, ATP successfully terminated 68% of VT episodes preoperatively and 59% post-implantation.
- During a 12-month follow-up, ATP success rate reached 92% for 2097 arrhythmia episodes.
- No significant difference in termination rates was observed between ATP modes A, B, and C.
Conclusions:
- Antitachycardia pacing is a highly effective strategy for patients with sustained VT.
- The tested ATP modes demonstrated comparable efficacy in terminating VT episodes.
- Further research may be needed to identify potential differences in specific patient subgroups.
Abstract:
The most effective antitachycardia pacing (ATP) mode is still a matter of debate. Randomized prospective testing of 3 different ATP modes was performed in 65 patients (pts) prior to and after cardioverter defibrillator implantation (Ventak PRx 36 pts, Cadence V 100 29 pts). All 3 ATP modes included 4 stimulation attempts with 4-7 adaptive scanning burst pulses. Adaptive burst coupling interval was 75% in mode A, 81% in mode B and 69% in mode C. Autodecremental scanning within bursts was 8 msec in all, decremental scanning between bursts was 8 msec in modes B and C. Each ATP mode had to be tested 3 times; all 3 ATP modes were randomly applied to each pt. During preoperative testing 91 of 133 VT episodes (68%) could be terminated by ATP. Termination was achieved in 68% with mode A, 68% with mode B and 73% with mode C. During predischarge testing, 251 VTs were induced and ATP was successful in 147 VTs (59%). Termination rate was 56% with mode A, 68% with mode B and 50% with mode C. During the mean follow-up of 12 months, 2301 arrhythmia episodes (AE) occurred. ATP was performed in 2097 AE (91%) and successful in 1920 AE (92%). Acceleration of VT occurred in 65 AE (3%) and unsuccessful ATP was observed in 112 AE (5%). It is concluded that ATP in general is highly effective in pts with sustained VT. None of the tested ATP modes, however, proved to be superior to the other.