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Experience with three different third-generation cardioverter-defibrillators in patients with coronary artery disease
J G Porterfield1, L M Porterfield, B A Smith
1Methodist Hospital, Memphis, Tennessee.
Insights
This study shows that third-generation pacemakers effectively treat malignant ventricular arrhythmias. Antitachycardia pacing successfully terminated most tachyarrhythmias, though some reprogramming was needed.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Malignant ventricular arrhythmias pose a significant threat to patient survival.
- Multiprogrammable devices offer advanced therapeutic options including antitachycardia pacing, cardioversion, and defibrillation.
- Third-generation tiered therapy devices aim to provide comprehensive arrhythmia management.
Purpose of the Study:
- To evaluate the safety and efficacy of three third-generation devices (Medtronic PCD, Ventritex Cadence, CPI VENTAK PRx) for treating malignant ventricular arrhythmias.
- To determine if antitachycardia pacing is a desirable and frequently utilized feature in tiered devices.
Main Methods:
- A single-center clinical investigation involving 46 patients with cardiac arrest or ventricular tachycardia.
- Implantation of Medtronic PCD, Ventritex Cadence, or CPI VENTAK PRx devices.
- Follow-up assessment of device performance, including antitachycardia pacing success rates and cardioversion/defibrillation efficacy.
Main Results:
- Antitachycardia pacing successfully terminated 98% of spontaneous tachyarrhythmia episodes when activated.
- 70% of patients with activated antitachycardia pacing used the feature for spontaneous ventricular tachycardia.
- Low-energy cardioversion or defibrillation successfully treated 35% of tachycardia episodes where pacing was unsuccessful.
- No deaths were attributed to device failure during the follow-up period.
Conclusions:
- The Medtronic PCD, Ventritex Cadence, and CPI VENTAK PRx are safe and effective tiered therapy devices for malignant ventricular arrhythmias.
- Antitachycardia pacing is a valuable feature, frequently used and highly successful in terminating ventricular tachycardia, though reprogramming may be necessary.
- These devices represent a significant advancement in managing life-threatening ventricular arrhythmias.
Abstract:
Clinical investigations are being performed in multiprogrammable devices whose therapeutic options include antitachycardia pacing, cardioversion, defibrillation and bradycardia pacing. Three different third-generation devices were implanted in 46 research patients at 1 clinical center to document their safety and efficacy for the treatment of malignant ventricular arrhythmias. Additionally, the purpose of the study was to determine if antitachycardia pacing is a desirable and frequently used feature of tiered devices. The Medtronic PCD was implanted in 15 patients (12 men, mean age 60 +/- 13 years, mean ejection fraction 40 +/- 15%), the Ventritex Cadence in 21 patients (17 men, mean age 65 +/- 10 years, mean ejection fraction 38 +/- 12%), and the CPI VENTAK PRx in 10 patients (8 men, mean age 63 +/- 14 years, mean ejection fraction 31 +/- 8%). All patients presented with cardiac arrest or ventricular tachycardia. During follow-up of 10 +/- 6 months (range 1 to 19), 70% of the 20 patients with antitachycardia pacing activated used the feature for spontaneous ventricular tachycardia. The antitachycardia pacing parameters were reprogrammed 20 times in 15 patients. Two thousand six hundred thirty-eight of 2,675 (98%) antitachycardia pacing attempts successfully terminated spontaneous tachyarrhythmias. Low-energy cardioversion or defibrillation terminated tachyarrhythmias in patients where pacing was unsuccessful. One hundred forty-eight episodes of tachycardia were successfully treated directly by shocks in 16 of 46 patients (35%). There were no deaths due to device failure. This initial single-center clinical experience suggests that the PCD, Cadence and VENTAK PRx are all safe and effective tiered therapy devices for the treatment of malignant ventricular arrhythmias. Antitachycardia pacing successfully terminated most episodes of ventricular tachycardia; in patients with this feature activated, it was used frequently but required reprogramming to achieve high levels of success.