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Background  Antitachycardia pacing (ATP) is an effective treatment for ventricular tachycardia (VT). We evaluated the efficacy of different ATP programs based on a large remote monitoring data set from patients with implantable cardioverter-defibrillators (ICDs).    Methods  A dataset from 18,679 ICD patients was used to evaluate the first delivered ATP treatment. We considered all device programs that were used for at least 50 patients, leaving us with 7 different programs and a total of 32,045 episodes. We used the two-proportions z-test (α = 0.01) to compare the probability of success and the probability for acceleration in each group with the corresponding values of the default setting.    Results  Overall, the first ATP treatment terminated in 78.4%–97.5% of episodes with slow VT and 81.5%–91.1% of episodes with fast VT. The default setting of the ATP programs with the number of sequences S = 3 was applied to treat 30.1% of the slow and 36.6% of the fast episodes. Reducing the maximum number of sequences to S = 2 decreased the success rate for slow VT ( P  < 0.0001,  h  = 0.38), while the setting S = 4 resulted in the highest success rate of 97.5% ( P < 0 . 0001 ,  h  = 0.27).    Conclusion  While the default programs performed well, we found that increasing the number of sequences from 3 to 4 was a promising option to improve the overall ATP performance.

Impact of device programming on the success of the first anti-tachycardia pacing therapy: An anonymized large-scale study