A Randomized Study to Compare Ramp Versus Burst Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators
| Autor: | Andrea Grammatico, Leandro G Piraino, Ignazio Vaccaro, Salvatore Mangiameli, Elisabetta Santi, Calogero Puntrello, Maria Carmela Scianaro, Marino Scherillo, Giacomo Chiarandà, Franco Mascia, Michele Massimo Gulizia, Orazio Pensabene, Salvatore Giglia, Calogero Vasco, Dario Corrao |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Male
Tachycardia medicine.medical_specialty Heart disease Defibrillation medicine.medical_treatment Ventricular tachycardia Syncope law.invention Randomized controlled trial law Physiology (medical) Internal medicine medicine Humans Aged business.industry Cardiac Pacing Artificial Reentry Middle Aged medicine.disease Implantable cardioverter-defibrillator Defibrillators Implantable Surgery Hospitalization Treatment Outcome Quality of Life Tachycardia Ventricular Cardiology Antitachycardia Pacing Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Circulation: Arrhythmia and Electrophysiology. 2:146-153 |
| ISSN: | 1941-3084 1941-3149 |
| DOI: | 10.1161/circep.108.804211 |
| Popis: | Background— In patients with implantable cardioverter-defibrillators (ICDs), antitachycardia pacing (ATP) is highly effective in terminating fast ventricular tachycardias (FVTs) and lowers the use of high-energy shocks, without increasing the risk of arrhythmia acceleration or syncope. Methods and Results— The aim of the PITAGORA ICD trial was to randomly compare 2 ATP strategies (88% coupling interval burst versus 91% coupling interval ramp, both 8 pulses) in terms of ATP efficacy, arrhythmia acceleration, and syncope. Two hundred six ICD patients (83% male, 67�11 years) were enrolled. FVT episodes with cycle lengths between 240 and 320 ms were treated by 1 ATP sequence and, in the event of failure, by shocks. Over a median follow-up of 36 months, 829 spontaneous ventricular tachyarrhythmia episodes were detected in 79 patients. Episode review identified 595 episodes as true ventricular arrhythmias in 72 patients; devices classified 111 (18.7%) episodes as VF, 216 (36.3%) as FVT, and 268 (45.0%) as VT. Fifty-six patients had 214 treated FVT episodes—2 FVTs self-terminated before ATP release; 44 (79%) of these had at least 1 effective ATP intervention, and 34 (61%) were spared ICD shocks. Burst terminated 100 of 133 (75.2%) FVT episodes, whereas ramp terminated 44 of 81 (54.3%; P =0.015). Acceleration occurred in 9 of 214 (4.2%) FVT episodes treated: 6 episodes in 3 ramp patients and 3 episodes in 3 burst patients. Two patients—1 in each group—suffered 1 syncopal event associated to a nonterminated FVT episode. Conclusions— Burst is significantly more efficacious than ramp in terminating FVT episodes. As the first therapy for FVT episodes, ATP carries a low risk of acceleration or syncopal events. |
| Databáze: | OpenAIRE |
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