Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks

Boyoung Joung, Daniel R. Lexcen, Chi Keong Ching, Marc T. Silver, Jonathan P. Piccini, Laurence D. Sterns, Rafael Rabinovich, Robert A. Pickett, Shufeng Liu, Mark L. Brown, Alan Cheng

Research output: Contribution to journalArticle

Abstract

Background: Antitachycardia pacing (ATP) is routinely used to terminate ventricular tachyarrhythmias (VTs). However, little guidance exists on the most effective programming of ATP. Objective: This study evaluated whether additional ATP sequences are more effective in reducing implantable cardioverter-defibrillator shocks. Methods: In patients from the Shock-Less study, the number of overall shocks were compared between patients programmed to ≤3 ATP sequences (VT zone) and ≤1 ATP sequence (fast ventricular tachycardia [FVT] zone) (nominal group) and patients programmed to receive additional ATP sequences in VT (>3) or FVT (>1) zones. Results: Of the 4112 patients (15% receiving secondary prevention; 77% men; mean age 65.9 ± 12.6 years), 1532 patients (37%) were programmed with additional ATP sequences (1025 with >3 ATP sequences in the VT zone; 699 patients with >1 ATP sequence in the FVT zone). Over a mean follow-up period of 19.6 ± 10.7 months, 4359 VT/FVT episodes occurred in 591 patients. Compared with the nominal group, in patients with additional ATP programming, there was a 39% reduction in the number of shocked VT episodes (0.46 episodes per patient-year vs 0.28 episodes per patient-year; incidence rate ratio [IRR] 0.61; P < .001) and a 44% reduction in the number of shocked FVT episodes (0.83 episodes per patient-year vs 0.47 episodes per patient-year; IRR 0.56; P < .001). The reduction in shocked VT episodes was observed in both primary (IRR 0.68; 95% confidence interval 0.51–0.90; P = .007) and secondary (IRR 0.51; 95% confidence interval 0.35–0.72; P < .001) prevention patients. Conclusion: Programming more than the nominal number of ATP sequences in both the VT and FVT zones is associated with a lower occurrence of implantable cardioverter-defibrillator shocks in clinical practice.

Original languageEnglish
JournalHeart Rhythm
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Implantable Defibrillators
Shock
Tachycardia
Ventricular Tachycardia
Incidence
Confidence Intervals
Secondary Prevention

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Joung, Boyoung ; Lexcen, Daniel R. ; Ching, Chi Keong ; Silver, Marc T. ; Piccini, Jonathan P. ; Sterns, Laurence D. ; Rabinovich, Rafael ; Pickett, Robert A. ; Liu, Shufeng ; Brown, Mark L. ; Cheng, Alan. / Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks. In: Heart Rhythm. 2019.
@article{f11b91581b3143fc8136d2f782246242,
title = "Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks",
abstract = "Background: Antitachycardia pacing (ATP) is routinely used to terminate ventricular tachyarrhythmias (VTs). However, little guidance exists on the most effective programming of ATP. Objective: This study evaluated whether additional ATP sequences are more effective in reducing implantable cardioverter-defibrillator shocks. Methods: In patients from the Shock-Less study, the number of overall shocks were compared between patients programmed to ≤3 ATP sequences (VT zone) and ≤1 ATP sequence (fast ventricular tachycardia [FVT] zone) (nominal group) and patients programmed to receive additional ATP sequences in VT (>3) or FVT (>1) zones. Results: Of the 4112 patients (15{\%} receiving secondary prevention; 77{\%} men; mean age 65.9 ± 12.6 years), 1532 patients (37{\%}) were programmed with additional ATP sequences (1025 with >3 ATP sequences in the VT zone; 699 patients with >1 ATP sequence in the FVT zone). Over a mean follow-up period of 19.6 ± 10.7 months, 4359 VT/FVT episodes occurred in 591 patients. Compared with the nominal group, in patients with additional ATP programming, there was a 39{\%} reduction in the number of shocked VT episodes (0.46 episodes per patient-year vs 0.28 episodes per patient-year; incidence rate ratio [IRR] 0.61; P < .001) and a 44{\%} reduction in the number of shocked FVT episodes (0.83 episodes per patient-year vs 0.47 episodes per patient-year; IRR 0.56; P < .001). The reduction in shocked VT episodes was observed in both primary (IRR 0.68; 95{\%} confidence interval 0.51–0.90; P = .007) and secondary (IRR 0.51; 95{\%} confidence interval 0.35–0.72; P < .001) prevention patients. Conclusion: Programming more than the nominal number of ATP sequences in both the VT and FVT zones is associated with a lower occurrence of implantable cardioverter-defibrillator shocks in clinical practice.",
author = "Boyoung Joung and Lexcen, {Daniel R.} and Ching, {Chi Keong} and Silver, {Marc T.} and Piccini, {Jonathan P.} and Sterns, {Laurence D.} and Rafael Rabinovich and Pickett, {Robert A.} and Shufeng Liu and Brown, {Mark L.} and Alan Cheng",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.hrthm.2019.07.027",
language = "English",
journal = "Heart Rhythm",
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Joung, B, Lexcen, DR, Ching, CK, Silver, MT, Piccini, JP, Sterns, LD, Rabinovich, R, Pickett, RA, Liu, S, Brown, ML & Cheng, A 2019, 'Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.07.027

Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks. / Joung, Boyoung; Lexcen, Daniel R.; Ching, Chi Keong; Silver, Marc T.; Piccini, Jonathan P.; Sterns, Laurence D.; Rabinovich, Rafael; Pickett, Robert A.; Liu, Shufeng; Brown, Mark L.; Cheng, Alan.

In: Heart Rhythm, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Additional antitachycardia pacing programming strategies further reduce unnecessary implantable cardioverter-defibrillator shocks

AU - Joung, Boyoung

AU - Lexcen, Daniel R.

AU - Ching, Chi Keong

AU - Silver, Marc T.

AU - Piccini, Jonathan P.

AU - Sterns, Laurence D.

AU - Rabinovich, Rafael

AU - Pickett, Robert A.

AU - Liu, Shufeng

AU - Brown, Mark L.

AU - Cheng, Alan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Antitachycardia pacing (ATP) is routinely used to terminate ventricular tachyarrhythmias (VTs). However, little guidance exists on the most effective programming of ATP. Objective: This study evaluated whether additional ATP sequences are more effective in reducing implantable cardioverter-defibrillator shocks. Methods: In patients from the Shock-Less study, the number of overall shocks were compared between patients programmed to ≤3 ATP sequences (VT zone) and ≤1 ATP sequence (fast ventricular tachycardia [FVT] zone) (nominal group) and patients programmed to receive additional ATP sequences in VT (>3) or FVT (>1) zones. Results: Of the 4112 patients (15% receiving secondary prevention; 77% men; mean age 65.9 ± 12.6 years), 1532 patients (37%) were programmed with additional ATP sequences (1025 with >3 ATP sequences in the VT zone; 699 patients with >1 ATP sequence in the FVT zone). Over a mean follow-up period of 19.6 ± 10.7 months, 4359 VT/FVT episodes occurred in 591 patients. Compared with the nominal group, in patients with additional ATP programming, there was a 39% reduction in the number of shocked VT episodes (0.46 episodes per patient-year vs 0.28 episodes per patient-year; incidence rate ratio [IRR] 0.61; P < .001) and a 44% reduction in the number of shocked FVT episodes (0.83 episodes per patient-year vs 0.47 episodes per patient-year; IRR 0.56; P < .001). The reduction in shocked VT episodes was observed in both primary (IRR 0.68; 95% confidence interval 0.51–0.90; P = .007) and secondary (IRR 0.51; 95% confidence interval 0.35–0.72; P < .001) prevention patients. Conclusion: Programming more than the nominal number of ATP sequences in both the VT and FVT zones is associated with a lower occurrence of implantable cardioverter-defibrillator shocks in clinical practice.

AB - Background: Antitachycardia pacing (ATP) is routinely used to terminate ventricular tachyarrhythmias (VTs). However, little guidance exists on the most effective programming of ATP. Objective: This study evaluated whether additional ATP sequences are more effective in reducing implantable cardioverter-defibrillator shocks. Methods: In patients from the Shock-Less study, the number of overall shocks were compared between patients programmed to ≤3 ATP sequences (VT zone) and ≤1 ATP sequence (fast ventricular tachycardia [FVT] zone) (nominal group) and patients programmed to receive additional ATP sequences in VT (>3) or FVT (>1) zones. Results: Of the 4112 patients (15% receiving secondary prevention; 77% men; mean age 65.9 ± 12.6 years), 1532 patients (37%) were programmed with additional ATP sequences (1025 with >3 ATP sequences in the VT zone; 699 patients with >1 ATP sequence in the FVT zone). Over a mean follow-up period of 19.6 ± 10.7 months, 4359 VT/FVT episodes occurred in 591 patients. Compared with the nominal group, in patients with additional ATP programming, there was a 39% reduction in the number of shocked VT episodes (0.46 episodes per patient-year vs 0.28 episodes per patient-year; incidence rate ratio [IRR] 0.61; P < .001) and a 44% reduction in the number of shocked FVT episodes (0.83 episodes per patient-year vs 0.47 episodes per patient-year; IRR 0.56; P < .001). The reduction in shocked VT episodes was observed in both primary (IRR 0.68; 95% confidence interval 0.51–0.90; P = .007) and secondary (IRR 0.51; 95% confidence interval 0.35–0.72; P < .001) prevention patients. Conclusion: Programming more than the nominal number of ATP sequences in both the VT and FVT zones is associated with a lower occurrence of implantable cardioverter-defibrillator shocks in clinical practice.

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