doi: 10.1161/hc3101.093906
(Circulation. 2001;104:796.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients With Coronary Artery Disease
Investigators
From Vanderbilt University Medical Center, Nashville, Tenn (M.S.W.); Brigham and Women’s Hospital, Boston, Mass (M.O.S.); Medtronic, Inc, Minneapolis, Minn (P.J.D., A.J.S., J.L.K.); St Joseph’s Hospital, Savannah, Ga (M.B.C.); Providence Hospital, Southfield, Mich (C.M.); and Park Nicollet Heart Center, St Louis Park, Minn (W.O.A.).
Correspondence to Mark Wathen, MD, Vanderbilt Page-Campbell Heart Institute, Vanderbilt University Medical Center, 2220 Pierce, Nashville, TN 37232. E-mail mark.wathen{at}mcmail.vanderbilt.edu
Background— Implantable cardioverter-defibrillators (ICDs) can terminate some ventricular tachycardias (VTs) painlessly with antitachycardia pacing (ATP). ATP has not routinely been applied for VT >188 bpm because of concerns about efficacy, risk of acceleration, and delay of definitive shock therapy. This prospective, multicenter study evaluated the efficacy of empirical ATP to terminate fast VT (FVT; >188 bpm).
Methods and Results— Two hundred twenty coronary artery disease patients received ICDs for standard indications. Empirical, standardized therapy was programmed so that all FVT episodes (average cycle length [CL] 240 to 320 ms, 250 to 188 bpm) were treated with 2 ATP sequences (8-pulse burst pacing train at 88% of the FVT CL) before shock delivery. A total of 1100 episodes of spontaneous ventricular tachyarrhythmias occurred during a mean of 6.9±3.6 months of follow-up. Fifty-seven percent were classified as slow VT (CL
320 ms), 40% as FVT (240 ms
CL<320 ms), and 3% as ventricular fibrillation (CL<240 ms). A total of 446 FVT episodes, mean CL=301±24 ms, occurred in 52 patients (median 2 episodes per patient). ATP terminated 396 FVT episodes (89%), with an adjusted efficacy of 77% (95% CI 68% to 83%). VT acceleration caused by ATP occurred in 10 FVT episodes (4%). FVT arrhythmic syncope occurred on 9 occasions (2%) in 4 patients.
Conclusions— FVT (CL<320 ms) is common in ICD patients. ATP can terminate 3 of 4 of these episodes with a low incidence of acceleration and syncope. ATP for FVT may safely reduce the morbidity of painful shocks.
Key Words: tachycardia • cardioversion • defibrillation • pacing
This article has been cited by other articles:
 |
|
 |
|
  A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Callans Patients With Hemodynamically Tolerated Ventricular Tachycardia Require Implantable Cardioverter Defibrillators Circulation, September 4, 2007; 116(10): 1196 - 1203. [Full Text] [PDF]
|
|
|
|
|
|
J. Almendral and M. E. Josephson All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator Circulation, September 4, 2007; 116(10): 1204 - 1212. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Singh and M. M. Murawski Implantable Cardioverter Defibrillator Therapy and the Need for Concomitant Antiarrhythmic Drugs Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2007; 12(3): 175 - 180. [Abstract] [PDF]
|
|
|
|
|
|
A. E. Epstein, C. A. Baessler, A. B. Curtis, N.A. M. Estes III, B. J. Gersh, B. Grubb, and L. B. Mitchell Addendum to "Personal and Public Safety Issues Related to Arrhythmias That May Affect Consciousness: Implications for Regulation and Physician Recommendations: A Medical/ Scientific Statement From the American Heart Association and the North American Society of Pacing and Electrophysiology" Public Safety Issues in Patients With Implantable Defibrillators A Scientific Statement From the American Heart Association and the Heart Rhythm Society Circulation, March 6, 2007; 115(9): 1170 - 1176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. L. Wilkoff, K. T. Ousdigian, L. D. Sterns, Z. J. Wang, R. D. Wilson, J. M. Morgan, and for the EMPIRIC Trial Investigators A Comparison of Empiric to Physician-Tailored Programming of Implantable Cardioverter-Defibrillators: Results From the Prospective Randomized Multicenter EMPIRIC Trial J. Am. Coll. Cardiol., July 18, 2006; 48(2): 330 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Abello, J. L. Merino, R. Peinado, M. Gnoatto, M. A. Arias, M. Gonzalez-Vasserot, and J. A. Sobrino Syncope following cardioverter defibrillator implantation in patients with spontaneous syncopal monomorphic ventricular tachycardia Eur. Heart J., January 1, 2006; 27(1): 89 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. O. Sweeney, M. S. Wathen, K. Volosin, I. Abdalla, P. J. DeGroot, M. F. Otterness, and A. J. Stark Appropriate and Inappropriate Ventricular Therapies, Quality of Life, and Mortality Among Primary and Secondary Prevention Implantable Cardioverter Defibrillator Patients: Results From the Pacing Fast VT REduces Shock ThErapies (PainFREE Rx II) Trial Circulation, June 7, 2005; 111(22): 2898 - 2905. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Jimenez-Candil, A. Arenal, A. Garcia-Alberola, M. Ortiz, S. d. Castillo, J. Fernandez-Portales, J. Sanchez-Munoz, J. Martinez-Sanchez, E. Gonzalez-Torrecilla, F. Atienza, et al. Fast ventricular tachycardias in patients with implantable cardioverter-defibrillators: Efficacy and safety of antitachycardia pacing: A prospective and randomized study J. Am. Coll. Cardiol., February 1, 2005; 45(3): 460 - 461. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Wathen, P. J. DeGroot, M. O. Sweeney, A. J. Stark, M. F. Otterness, W. O. Adkisson, R. C. Canby, K. Khalighi, C. Machado, D. S. Rubenstein, et al. Prospective Randomized Multicenter Trial of Empirical Antitachycardia Pacing Versus Shocks for Spontaneous Rapid Ventricular Tachycardia in Patients With Implantable Cardioverter-Defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) Trial Results Circulation, October 26, 2004; 110(17): 2591 - 2596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B. Curtis Filling the need for new antiarrhythmic drugs to prevent shocks from implantable cardioverter defibrillators J. Am. Coll. Cardiol., January 7, 2004; 43(1): 44 - 46. [Full Text] [PDF]
|
|
|
|
 |
|
 H.-N. Pak, Y.-B. Liu, H. Hayashi, Y. Okuyama, P.-S. Chen, and S.-F. Lin Synchronization of ventricular fibrillation with real-time feedback pacing: implication to low-energy defibrillation Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2704 - H2711. [Abstract] [Full Text] [PDF]
|
|