Antitachycardia pacing success in implantable cardioverter-defibrillators by patient, device, and programming characteristics

Laurence D Sterns; Angelo Auricchio; Edward J Schloss; Dan Lexcen; Luke Jacobsen; Paul DeGroot; Amy Molan; Takashi Kurita

doi:10.1016/j.hrthm.2022.10.015

Antitachycardia pacing success in implantable cardioverter-defibrillators by patient, device, and programming characteristics

Heart Rhythm. 2023 Feb;20(2):190-197. doi: 10.1016/j.hrthm.2022.10.015. Epub 2022 Oct 19.

Authors

Laurence D Sterns¹, Angelo Auricchio², Edward J Schloss³, Dan Lexcen⁴, Luke Jacobsen⁴, Paul DeGroot⁴, Amy Molan⁴, Takashi Kurita⁵

Affiliations

¹ Vancouver Island Arrhythmia Clinic, Victoria, British Columbia, Canada. Electronic address: [email protected].
² Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland.
³ The Christ Hospital, Cincinnati, Ohio.
⁴ Medtronic Inc., Mounds View, Minnesota.
⁵ Division of Cardiology, Department of Medicine, Kindai University School of Medicine, Osaka, Japan.

PMID: 36272710
DOI: 10.1016/j.hrthm.2022.10.015

Abstract

Background: Antitachycardia pacing (ATP) is an established implantable cardioverter-defibrillator (ICD) therapy that terminates ventricular tachycardias (VTs) without painful ICD shocks. However, factors influencing ATP success are not well understood.

Objective: The purpose of this study was to examine ATP success rates by patient, device, and programming characteristics.

Methods: This retrospective analysis of the PainFree SmartShock Technology study included spontaneous ATP-treated monomorphic VT episodes. ATP success rates were calculated for various factors. Also, the relationship of ATP programming on shock burden and syncope were investigated.

Results: Of the 2770 enrolled patients (2200 [79%] male; mean age 65 years), 1699 (61%) received an ICD and 1071 (39%) a cardiac resynchronization therapy - defibrillator. ATP had >80% rate of success for terminating VTs overall, with similar rates observed between ICD and cardiac resynchronization therapy - defibrillator devices (82.2% vs 80.3%, respectively; P = .81) as well as between primary and secondary prevention patients with ICDs (77.2% vs 83.9% respectively; P = .25). Arrhythmias with a median cycle length of ≥320 ms had a significantly higher ATP success rate (88.0%; 95% confidence interval 84.8%-90.6%). The cumulative percentage of ATP success increased from 71% at 1 ATP sequence delivered to 87% at ≥8 sequences delivered. Programming more ATP sequences was associated with lower shock burden (P = .0005). There was no evidence that more sequences were associated with higher rates of syncope (P = .16).

Conclusion: Delivering more ATP sequences resulted in a higher overall success of terminating VTs, while programming more ATP was associated with decreased shock burden and no evidence of increased syncope or acceleration. This suggests that more ATP sequences should be programmed when possible, but confirmation in prospective studies will be necessary.

Keywords: Antitachycardia pacing; Cardiac resynchronization therapy; Device programming; Implantable cardioverter-defibrillator; Shock reduction; defibrillator.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenosine Triphosphate
Aged
Cardiac Resynchronization Therapy*
Defibrillators, Implantable*
Female
Humans
Male
Prospective Studies
Retrospective Studies
Syncope / therapy
Tachycardia, Ventricular*
Treatment Outcome

Substances

Adenosine Triphosphate