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(Circulation. 2005;112:946-953.)
© 2005 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Incidence and Clinical Relevance of Slow Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients

An International Multicenter Prospective Study

Nicolas Sadoul, MD; Ralph Mletzko, MD; Frédéric Anselme, MD, PhD; Robert Bowes, MD; Wolfgang Schöls, MD; Claude Kouakam, MD; Gaëlle Casteigneau, MD; Raffaele Luise, MD; Nicolas Iscolo, MS; Etienne Aliot, MD, for the Slow VT Study Group

From CHU de Nancy Brabois, Vandoeuvre les Nancy, Nancy (N.S., E.A.), CHU Charles Nicolle, Rouen (F.A.), Hôpital Cardiologique, CHU de Lille, Lille (C.K.), CHU de Rangueil, Toulouse (G.C.), Ela Medical, and Le Plessis Robinson (N.I.), France; Herz-Kreislaufklinik Bevensen, Bad-Bevensen (R.M.), and Universitätskliniken Heidelberg, Heidelberg (W.S.), Germany; Northern General Hospital, Sheffield (R.B.), United Kingdom; and Ospedale Santo Spirito, Pescara (R.L.), Italy.

Correspondence to Nicolas Sadoul, MD, Département de Cardiologie, CHU Nancy Brabois, Rue du Morvan, 54500 Vandoeuvre les Nancy, France. E-mail n.sadoul{at}chu-nancy.fr

Received January 3, 2005; revision received April 15, 2005; accepted May 3, 2005.

Background— This study aims to assess the incidence and clinical relevance of slow ventricular tachycardia (VT) and the effectiveness and/or deleterious effects of antitachycardia pacing in slow VT in implantable cardioverter-defibrillator recipients.

Methods and Results— This multicenter prospective randomized study included 374 patients (326 men) without prior history of slow VT (<148 bpm) implanted with a dual-chamber implantable cardioverter-defibrillator. Patients had a 3-zone detection configuration: a slow VT zone (101 to 148 bpm), a conventional VT zone (>148 bpm), and a ventricular fibrillation zone. Patients were randomized to a treatment group (n=183) with therapy activated in the slow VT zone or a monitoring group (n=191) with no therapy in the slow VT zone. During follow-up (11 months), 449 slow VTs occurred in 114 patients (30.5% slow VT incidence); 181 VTs (54 patients) occurred in the monitoring group; 3 were readmitted to the hospital; and lightheadedness and palpitations occurred in 4 and 250 (60 patients) in the treatment group treated by antitachycardia pacing (89.8% success rate) and shock delivery (n=2). There were 10 crossovers from the monitoring to treatment group and 3 crossovers from the treatment to monitoring group (P=0.09). Quality of life scores were not different between groups.

Conclusions— Slow VT incidence (<150 bpm) is high (30%) in implantable cardioverter-defibrillator recipients without prior history of slow VT, has limited clinical relevance, and is efficiently and safely terminated by antitachycardia pacing.

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CLINICAL PERSPECTIVE

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