Abstract 5893: Biventricular Versus Right Ventricular Delivered Anti-Tachicardia Pacing for the Termination Of Ventricular Tachyarrhythmias in Heart Failure Patients Receiving a Biventricular ICD: Results from the ADVANCE CRT-D Trial
Aim: To investigate the efficacy and safety of anti-tachycardia pacing (ATP) simultaneously delivered from right and left ventricles (BIV) vs conventional right ventricular (RV) delivery in heart failure (HF) patients treated with a biventricular ICD (CRT-D).
Methods: Multicenter, prospective, randomized, controlled trial of pts implanted with a Medtronic CRT-D device. Anti-tachycardia detections were programmed: VF detection set at NID 18/24 for ≥250 bpm; FVT (via VF) with NID 18/24 between 188–250 bpm; VT detected when 20 consecutive RR intervals ≥143 bpm. Randomization was 1:1 to either BiV or RV ATP (single burst 8 pulse, 88% coupling interval ). Pts were followed for 12 months. Stored EGM, used to classify all spontaneous episodes, as well as all adverse events (including death) were adjudicated by an independent committee adjusting for pts with multiple episodes. The primary end-point (PEP) compared the efficacy of first BiV vs RV to terminate any ventricular tachyarrhythmias (VTs). The secondary composite end-point (SEP) compared adverse events (accelerations+ syncope/pre-syncope) to assess safety.
Results: In total, 526 patients were enrolled and randomized (BiV = 260, RV = 266). There were no baseline differences between groups. In total, 1077 detections in 178 patients were recorded: 634 were true VTs in 119 patients (69 VF [11%] in 18 pts, 202 FVT [32%] in 49 pts, and 363 VT [57%] in 92 pts). PEP: Efficacy of first ATP was comparable between BiV (65%) and RV (68%) (p=0.58). In VT zone, RV was better (62% vs 71%., p=0.24), while in FVT zone BIV proved better (71% vs. 61%, p=0.33). RV ATP was significantly less effective in ischemic (I) pts (81% vs 59%, p=0.005). SEP: BIV ATP was ineffective 20 times and 3 accelerations occurred, whereas RV ATP failed 41 times and 14 accelerations occurred (p=0.12). Syncope/pre-syncope events never occurred for BiV ATP, while 4 times (3%) in RV ATP(p=0.3). No difference in mortality was observed.
Conclusion: This trial demonstrated that ATP is also effective in CRT-D recipients. No significant differences in overall ATP efficacy were found between BIV and RV, but RV was significantly less effective in I patients; BIV was effective across different etiologies and showed a trend for superior safety profile.