Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials

Alan Cheng; Boyoung Joung; Mark L. Brown; Jodi Koehler; Daniel R. Lexcen; Prashanthan Sanders; Kenneth A. Ellenbogen

doi:10.1111/jce.14688

Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials

Alan Cheng, Boyoung Joung, Mark L. Brown, Jodi Koehler, Daniel R. Lexcen, Prashanthan Sanders, Kenneth A. Ellenbogen

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods: This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ² tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240–310 ms) MVTs. Results: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p =.28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p =.27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p =.58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240–310 ms) episodes (84.1% vs. 69%; p <.001). Conclusion: In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.

Original language	English
Pages (from-to)	2720-2726
Number of pages	7
Journal	Journal of Cardiovascular Electrophysiology
Volume	31
Issue number	10
DOIs	https://doi.org/10.1111/jce.14688
Publication status	Published - 2020 Oct 1

Bibliographical note

Funding Information:
: Alan Cheng, Mark L. Brown, Jodi Koehler, and Daniel R. Lexcen are employees of Medtronic. Boyoung Joung reports having served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi‐Sankyo, and has received research funds from Medtronic and Abbott. Prashanthan Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. He also serves on the advisory board of Medtronic, Abbott, Boston Scientific, Pacemate and CathRx. The University of Adelaide reports receiving on behalf of Prashanthan Sanders lecture and/or consulting fees from Medtronic, Abbott, Boston Scientific, and Microport. Kenneth A. Ellenbogen reports having served as a consultant for Medtronic. Disclosure

Publisher Copyright:
© 2020 Wiley Periodicals LLC

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine
Physiology (medical)

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Cheng, A., Joung, B., Brown, M. L., Koehler, J., Lexcen, D. R., Sanders, P., & Ellenbogen, K. A. (2020). Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials. Journal of Cardiovascular Electrophysiology, 31(10), 2720-2726. https://doi.org/10.1111/jce.14688

Cheng, Alan ; Joung, Boyoung ; Brown, Mark L. ; Koehler, Jodi ; Lexcen, Daniel R. ; Sanders, Prashanthan ; Ellenbogen, Kenneth A. / Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy : A patient-level meta-analysis of three large clinical trials. In: Journal of Cardiovascular Electrophysiology. 2020 ; Vol. 31, No. 10. pp. 2720-2726.

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abstract = "Background: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods: This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ2 tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240–310 ms) MVTs. Results: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p =.28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p =.27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p =.58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240–310 ms) episodes (84.1% vs. 69%; p <.001). Conclusion: In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.",

author = "Alan Cheng and Boyoung Joung and Brown, {Mark L.} and Jodi Koehler and Lexcen, {Daniel R.} and Prashanthan Sanders and Ellenbogen, {Kenneth A.}",

note = "Funding Information: : Alan Cheng, Mark L. Brown, Jodi Koehler, and Daniel R. Lexcen are employees of Medtronic. Boyoung Joung reports having served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi‐Sankyo, and has received research funds from Medtronic and Abbott. Prashanthan Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. He also serves on the advisory board of Medtronic, Abbott, Boston Scientific, Pacemate and CathRx. The University of Adelaide reports receiving on behalf of Prashanthan Sanders lecture and/or consulting fees from Medtronic, Abbott, Boston Scientific, and Microport. Kenneth A. Ellenbogen reports having served as a consultant for Medtronic. Disclosure Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC",

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Cheng, A, Joung, B, Brown, ML, Koehler, J, Lexcen, DR, Sanders, P & Ellenbogen, KA 2020, 'Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials', Journal of Cardiovascular Electrophysiology, vol. 31, no. 10, pp. 2720-2726. https://doi.org/10.1111/jce.14688

Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy : A patient-level meta-analysis of three large clinical trials. / Cheng, Alan; Joung, Boyoung; Brown, Mark L.; Koehler, Jodi; Lexcen, Daniel R.; Sanders, Prashanthan; Ellenbogen, Kenneth A.

In: Journal of Cardiovascular Electrophysiology, Vol. 31, No. 10, 01.10.2020, p. 2720-2726.

Research output: Contribution to journal › Article › peer-review

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T1 - Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy

T2 - A patient-level meta-analysis of three large clinical trials

AU - Cheng, Alan

AU - Joung, Boyoung

AU - Brown, Mark L.

AU - Koehler, Jodi

AU - Lexcen, Daniel R.

AU - Sanders, Prashanthan

AU - Ellenbogen, Kenneth A.

N1 - Funding Information: : Alan Cheng, Mark L. Brown, Jodi Koehler, and Daniel R. Lexcen are employees of Medtronic. Boyoung Joung reports having served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi‐Sankyo, and has received research funds from Medtronic and Abbott. Prashanthan Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. He also serves on the advisory board of Medtronic, Abbott, Boston Scientific, Pacemate and CathRx. The University of Adelaide reports receiving on behalf of Prashanthan Sanders lecture and/or consulting fees from Medtronic, Abbott, Boston Scientific, and Microport. Kenneth A. Ellenbogen reports having served as a consultant for Medtronic. Disclosure Publisher Copyright: © 2020 Wiley Periodicals LLC

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Background: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods: This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ2 tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240–310 ms) MVTs. Results: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p =.28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p =.27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p =.58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240–310 ms) episodes (84.1% vs. 69%; p <.001). Conclusion: In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.

AB - Background: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods: This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ2 tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240–310 ms) MVTs. Results: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p =.28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p =.27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p =.58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240–310 ms) episodes (84.1% vs. 69%; p <.001). Conclusion: In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.

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Cheng A, Joung B, Brown ML, Koehler J, Lexcen DR, Sanders P et al. Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials. Journal of Cardiovascular Electrophysiology. 2020 Oct 1;31(10):2720-2726. https://doi.org/10.1111/jce.14688

Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials

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