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Changing trends in therapy delivery with a third generation noncommitted implantable defibrillator: results of a
R M Luceri1, S M Habal, I B David
1Interventional Cardiac Arrhythmia Center, Holy Cross Hospital, Fort Lauderdale, Florida.
Insights
This study shows that the 4210 ATP implantable cardioverter-defibrillator (ICD) effectively treats ventricular tachycardia (VT) using antitachycardia pacing (ATP). Extensive telemetry data aids in diagnosing episodes and optimizing therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Sudden cardiac death and ventricular tachycardia (VT) remain significant clinical challenges.
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing these conditions.
- Third-generation ICDs offer advanced features for arrhythmia detection and therapy.
Purpose of the Study:
- To evaluate the performance of the 4210 ATP ICD in patients with sudden cardiac death or VT.
- To assess the efficacy of antitachycardia pacing (ATP) in terminating VT episodes.
- To determine the diagnostic value of the device's telemetry logs and arrhythmia analysis.
Main Methods:
- Thirty-four patients received the 4210 ATP ICD.
- Clinical follow-up averaged 12.2 months, during which VT/VF detections were logged.
- Analysis focused on episode detection, ATP success rates, and inappropriate therapy causes.
Main Results:
- Over 26,500 VT/VF detections occurred; only 6% resulted in device therapy.
- ATP successfully terminated VT in 86.3% of episodes.
- Extensive telemetry logs facilitated diagnosis of inappropriate therapies, primarily in a small patient subset.
Conclusions:
- The 4210 ATP ICD performs as expected, providing valuable diagnostic data.
- Antitachycardia pacing (ATP) is an effective method for terminating VT.
- Advanced telemetry is crucial for accurate ICD therapy management and diagnosis.
Abstract:
Thirty-four patients underwent implantation of a third generation ICD, the 4210 ATP, for sudden cardiac death or ventricular tachycardia. This device incorporates significant telemetry logs as well as a detailed analysis of each arrhythmia episode detected. During the period of clinical follow-up, a mean of 12.2 months, a total of 26,569 VT or VF detections were made. The vast majority of these were either due to atrial fibrillation, nonsustained VT, or "noise" detection, and only 6% led to device therapy. ATP was successful in 86.3% of episodes, with 3.5% accelerations and 2.4% failure of ATP trains. The majority of inappropriate therapy episodes were clustered in seven patients, and all were easily diagnosed with the aid of the extensive telemetry logs and sense histories. Of five late deaths, three were from congestive heart failure, one from cerebrovascular accident, and one unknown. These data reveal that this "tiered" therapy noncommitted ICD performs to expectations; the stored data is of significant value in diagnosing the cause of ICD therapy. In addition, ATP is an effective modality for termination of VT.