Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device

Efficacy, safety, and impact on mortality

Maurizio Landolina, Maurizio Lunati, Giuseppe Boriani, Renato Pietro Ricci, Alessandro Proclemer, Domenico Facchin, Roberto Rordorf, Giovanni Morani, Massimiliano Maines, Gianni Gasparini, Giulio Molon, Pietro Turrini, Maurizio Gasparini

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Cardiac resynchronization therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via antitachycardia pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%-69%) on FVTs and 68% (95% CI 62%-74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3-7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4-6.1) in patients with inappropriate ATP (P =.045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

Original languageEnglish
Pages (from-to)472-480
Number of pages9
JournalHeart Rhythm
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 1 2016

Fingerprint

Cardiac Resynchronization Therapy Devices
Equipment Safety
Defibrillators
Heart Failure
Ventricular Tachycardia
Mortality
Therapeutics
Confidence Intervals
Atrial Fibrillation
Cardiac Resynchronization Therapy
Cardiac Arrhythmias
Safety
Implantable Defibrillators
Syncope
Disease Progression

Keywords

  • Antitachy-cardia pacingtherapy(ATP)
  • Death
  • Implantable cardioverter-defibrillators
  • Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device : Efficacy, safety, and impact on mortality. / Landolina, Maurizio; Lunati, Maurizio; Boriani, Giuseppe; Pietro Ricci, Renato; Proclemer, Alessandro; Facchin, Domenico; Rordorf, Roberto; Morani, Giovanni; Maines, Massimiliano; Gasparini, Gianni; Molon, Giulio; Turrini, Pietro; Gasparini, Maurizio.

In: Heart Rhythm, Vol. 13, No. 2, 01.02.2016, p. 472-480.

Research output: Contribution to journalArticle

Landolina, Maurizio ; Lunati, Maurizio ; Boriani, Giuseppe ; Pietro Ricci, Renato ; Proclemer, Alessandro ; Facchin, Domenico ; Rordorf, Roberto ; Morani, Giovanni ; Maines, Massimiliano ; Gasparini, Gianni ; Molon, Giulio ; Turrini, Pietro ; Gasparini, Maurizio. / Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device : Efficacy, safety, and impact on mortality. In: Heart Rhythm. 2016 ; Vol. 13, No. 2. pp. 472-480.
@article{c699e72f08144bf8813d30aedfd513a6,
title = "Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device: Efficacy, safety, and impact on mortality",
abstract = "Background Cardiac resynchronization therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via antitachycardia pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63{\%} (95{\%} confidence interval [CI] 57{\%}-69{\%}) on FVTs and 68{\%} (95{\%} CI 62{\%}-74{\%}) on VTs. Acceleration occurred in 55 (1.87{\%}) and syncope in 4 (0.14{\%}) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95{\%} CI 4.3-7.5) in patients with appropriate ATP and 1.5 (95{\%} CI 0.4-6.1) in patients with inappropriate ATP (P =.045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.",
keywords = "Antitachy-cardia pacingtherapy(ATP), Death, Implantable cardioverter-defibrillators, Safety",
author = "Maurizio Landolina and Maurizio Lunati and Giuseppe Boriani and {Pietro Ricci}, Renato and Alessandro Proclemer and Domenico Facchin and Roberto Rordorf and Giovanni Morani and Massimiliano Maines and Gianni Gasparini and Giulio Molon and Pietro Turrini and Maurizio Gasparini",
year = "2016",
month = "2",
day = "1",
doi = "10.1016/j.hrthm.2015.10.022",
language = "English",
volume = "13",
pages = "472--480",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device

T2 - Efficacy, safety, and impact on mortality

AU - Landolina, Maurizio

AU - Lunati, Maurizio

AU - Boriani, Giuseppe

AU - Pietro Ricci, Renato

AU - Proclemer, Alessandro

AU - Facchin, Domenico

AU - Rordorf, Roberto

AU - Morani, Giovanni

AU - Maines, Massimiliano

AU - Gasparini, Gianni

AU - Molon, Giulio

AU - Turrini, Pietro

AU - Gasparini, Maurizio

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background Cardiac resynchronization therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via antitachycardia pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%-69%) on FVTs and 68% (95% CI 62%-74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3-7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4-6.1) in patients with inappropriate ATP (P =.045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

AB - Background Cardiac resynchronization therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via antitachycardia pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%-69%) on FVTs and 68% (95% CI 62%-74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3-7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4-6.1) in patients with inappropriate ATP (P =.045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

KW - Antitachy-cardia pacingtherapy(ATP)

KW - Death

KW - Implantable cardioverter-defibrillators

KW - Safety

UR - http://www.scopus.com/inward/record.url?scp=84955581166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955581166&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2015.10.022

DO - 10.1016/j.hrthm.2015.10.022

M3 - Article

VL - 13

SP - 472

EP - 480

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 2

ER -