Abstract | BACKGROUND: This multicenter, prospective, randomized, controlled, parallel trial compares the efficacy of biventricular (BIV) versus right ventricular (RV) antitachycardia pacing ( ATP) in terminating all kinds of ventricular tachycardia (VT). METHODS: Five hundred twenty-six patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D) device were enrolled and randomized 1:1 to either BIV (266) or RV (260) ATP (single burst 8 pulse, 88% coupling interval) and were followed up for 12 months. RESULTS: During 12 months' follow-up, 1,077 ventricular episodes in 180 patients were detected and classified: 634 true VTs divided into 69 ventricular fibrillation (VF) (11%), 202 fast ventricular tachycardia (FVT) (32%), and 363 VT (57%). A comparable first ATP efficacy (BIV 65% vs RV 68%, P = .59) was observed in FVT + VT, in VT zone (BIV 62% vs RV 71%, P = .25), and in FVT zone (BIV 71% vs RV 61%, P = .34). A trend toward lower accelerations during ATP applied to FVT was observed in the BIV group (3.5% BIV vs 10.2% RV, P = .163). No syncope/ presyncope occurred during ATP for FVT in the BIV group versus 4 events (3.2%) in the RV group (P = .016). biventricular ATP was more effective in treating FVT in coronary artery disease (CAD) patients (P = .032), whereas both modalities presented similar efficacy in patients with non-CAD etiology (P = .549). CONCLUSIONS: Antitachycardia pacing is effective in patients implanted with a CRT-D device. No significant differences in efficacy emerged between BIV- and RV-delivered ATP in the general population, whereas BIV ATP seems to present a safer profile in ischemic patients.
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Authors | Maurizio Gasparini, Frédéric Anselme, Jacques Clementy, Massimo Santini, José Martínez-Ferrer, Tiziana De Santo, Elisabetta Santi, Jeorg O Schwab, ADVANCE CRT-D Investigators |
Journal | American heart journal
(Am Heart J)
Vol. 159
Issue 6
Pg. 1116-1123.e2
(Jun 2010)
ISSN: 1097-6744 [Electronic] United States |
PMID | 20569728
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
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Copyright | Copyright 2010 Mosby, Inc. All rights reserved. |
Topics |
- Aged
- Cardiac Pacing, Artificial
(methods)
- Defibrillators, Implantable
- Disease-Free Survival
- Electric Countershock
(instrumentation)
- Electrocardiography
- Female
- Follow-Up Studies
- Heart Ventricles
(physiopathology)
- Humans
- Male
- Prospective Studies
- Single-Blind Method
- Survival Rate
- Tachycardia, Ventricular
(mortality, physiopathology, therapy)
- Treatment Outcome
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