1. Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study.
- Author
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ANGUERA, IGNASI, DALLAGLIO, PAOLO, MARTÍNEZ‐FERRER, JOSE, RODRÍGUEZ, ANÍBAL, ALZUETA, JAVIER, PÉREZ‐VILLACASTÍN, JULIÁN, PORRES, JOSÉ MANUEL, VIÑOLAS, XAVIER, FONTENLA, ADOLFO, FERNÁNDEZ‐LOZANO, IGNACIO, GARCÍA‐ALBEROLA, ARCADIO, and SABATÉ, XAVIER
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VENTRICULAR tachycardia , *CARDIAC pacing , *CHI-squared test , *CLINICAL trials , *CONFIDENCE intervals , *FISHER exact test , *IMPLANTABLE cardioverter-defibrillators , *LONGITUDINAL method , *MEDICAL cooperation , *MULTIVARIATE analysis , *SCIENTIFIC observation , *PATIENT safety , *RESEARCH , *T-test (Statistics) , *TREATMENT effectiveness , *DATA analysis software , *DESCRIPTIVE statistics , *KAPLAN-Meier estimator , *ODDS ratio , *MANN Whitney U Test , *PREVENTION - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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