From the Departments of Cardiology and Thoracic Surgery, University
Hospital Göttingen, Germany.
Correspondence to Anselm Schaumann, MD, Department of Cardiology, University Hospital Göttingen, Robert-Koch-Str 40, 37075 Göttingen, Germany. E-mail: aschaum{at}gwdg.de
Background—Implantable
cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac
death. The objective of this study was to evaluate whether testing of
antitachycardia pacing (ATP) for induced
ventricular tachycardias (VTs) at predischarge
examination can predict ATP success during follow-up.
Methods and Results—The study covers 200 consecutive patients who
received ICD implants from June 1991 through December 1995. All
underwent electrophysiological testing. In
54 patients (ATP tested, group T), ATP terminated induced VTs
successfully. In 146 patients (empirically programmed ATP, group E),
only ventricular fibrillation could be induced, including
18 with unsuccessful ATP attempts for induced VTs. Disregarding the
results of ATP testing, the same ATP scheme was programmed in all
patients: three attempts of autodecremental ramp with 81% of the VT
cycle length, with 8 to 10 pulses. During a follow-up of 20.4±10
months, 95% of 3819 spontaneous VTs were successfully terminated with
ATP in 42 patients of group T. In group E, 90% of 1346 spontaneous VTs
in 81 patients were terminated with ATP. Acceleration after ATP
occurred in 2% in group T versus 5% in group E. The success for all
episodes in individual patients was
Conclusions—The results of this 200-patient prospective study
comparing tested versus empirical ATP show high success (95% versus
90%) for VT termination, with low rates of acceleration. ATP is safe
and very effective and should be programmed "on" in all patients
regardless of the predischarge EP inducibility.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Empirical Versus Tested Antitachycardia Pacing in Implantable Cardioverter Defibrillators
A Prospective Study Including 200 Patients
90% in >60% of the ATP tested
and empirically programmed patients.
Key Words: arrhythmia • tachycardia • heart assist device • pacing
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