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Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study
Author(s) -
ANGUERA IGNASI,
DALLAGLIO PAOLO,
MARTÍNEZFERRER JOSE,
RODRÍGUEZ ANÍBAL,
ALZUETA JAVIER,
PÉREZVILLACASTÍN JULIÁN,
PORRES JOSÉ MANUEL,
VIÑOLAS XAVIER,
FONTENLA ADOLFO,
FERNÁNDEZLOZANO IGNACIO,
GARCÍAALBEROLA ARCADIO,
SABATÉ XAVIER
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12699
Subject(s) - medicine , shock (circulatory) , cardiology , implantable cardioverter defibrillator , ventricular tachycardia , ventricular fibrillation , anesthesia
Multiple Bursts for Fast Ventricular Tachycardia Introduction An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter‐defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst. Methods and Results We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250–320 milliseconds) before shock therapy. Over a mean follow‐up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high‐energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7–6.8, P = 0.001) was an independent predictor of ATP effectiveness. Conclusion This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.