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Basal Exit Site of Clinical Ventricular Tachycardia is an Independent Predictor of Antitachycardia Pacing Failure in Implantable Cardioverter‐Defibrillators Recipients
Author(s) -
BOULÉ STÉPHANE,
BRIGADEAU FRANÇOIS,
MARQUIÉ CHRISTELLE,
SALLERON JULIA,
KLUG DIDIER,
KOUAKAM CLAUDE,
GUÉDONMOREAU LAURENCE,
DUHAMEL ALAIN,
ACHERÉ CHARLES,
WISSOCQUE LUDIVINE,
LACROIX DOMINIQUE,
KACET SALEM
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03478.x
Subject(s) - medicine , cardiology , interquartile range , basal (medicine) , implantable cardioverter defibrillator , ventricular tachycardia , tachycardia , insulin
Background: Little is known about predictors of antitachycardia pacing (ATP) failure in implantable cardioverter defibrillator (ICD) recipients. Distance between the stimulation site and the ventricular tachycardia (VT) site of origin may critically affect ATP effectiveness. We hypothesized that ATP may be less effective in ICD patients who had basal VT than in those who had apical VT.Methods: We reviewed data from 52 patients with sustained monomorphic VT and left ventricular disease referred for ICD implantation. ATP was delivered exclusively at the right ventricular apex. The clinical VTs site of origin (basal, midventricular, or apical) was determined in each patient, using 12‐lead electrocardiogram. VTs episodes treated with ATP during the 1‐year follow‐up were studied. ATP success rate (%), defined as the ratio between the number of successful ATP sequences and the number of delivered ATP sequences, was determined in each patient.Results: VT exit site was apical in 19 patients (36%), basal in 18 patients (35%), and midventricular in 15 patients (29%). In those 52 patients, 1,393 ATP sequences, delivered to treat 761 VT episodes, were analyzed. ATP success rate was found to be associated with the VT site of origin (median [interquartile range]): basal (33%[11–67]), midventricular (50%[37–100]), apical (100%[41–100]) (P = 0.027). Multivariate analysis identified basal VT site of origin as an independent predictor of ATP failure (P = 0.023).Conclusion: ATP is less effective in ICD patients who had basal VT than in those who had apical VT before ICD implantation. (PACE 2012; 35:1209–1216)