Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study
Por:
Anguera, I, Dallaglio, P, Martinez-Ferrer, J, Rodriguez, A, Alzueta, J, Perez-Villacastin, J, Porres, JM, Vinolas, X, Fontenla, A, Fernandez-Lozano, I, Garcia-Alberola, A, Sabate, X
Publicada:
1 jul 2015
Resumen:
Multiple Bursts for Fast Ventricular Tachycardia
IntroductionAn 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 ResultsWe 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.
ConclusionThis 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.
Filiaciones:
Anguera, I:
Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Heart Dis Inst, Dept Cardiol, Barcelona, Spain
Dallaglio, P:
Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Heart Dis Inst, Dept Cardiol, Barcelona, Spain
Martinez-Ferrer, J:
Hosp Univ Araba, Dept Cardiol, Vitoria, Spain
Rodriguez, A:
Hosp Univ Canarias, Dept Cardiol, Santa Cruz De Tenerife, Spain
Alzueta, J:
Hosp Virgen de la Victoria, Dept Cardiol, Malaga, Spain
Perez-Villacastin, J:
Hosp Clin San Carlos, Dept Cardiol, Madrid, Spain
Porres, JM:
Hosp Univ Donostia, Dept Cardiol, San Sebastian, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona, Spain
Fontenla, A:
Hosp 12 Octubre, Dept Cardiol, E-28041 Madrid, Spain
Fernandez-Lozano, I:
Hosp Univ Puerta de Hierro, Dept Cardiol, Majadahonda, Spain
Garcia-Alberola, A:
Hosp Univ Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Sabate, X:
Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Heart Dis Inst, Dept Cardiol, Barcelona, Spain
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