Abstract 14010: Anti-Tachycardia Pacing Efficacy in the Setting of Prolonged Arrhythmia Detection. New data from the ADVANCEIII study
Introduction: Shock therapy in ICD implanted population has been associated with increased morbitdity and new programming strategies have been evaluated to reduce ICD interventions. A prolonged number of intervals (NID) to detect arrhythmia has been shown to safely and effectively reduce unnecessary ICD therapy for episodes with cycle length ≤320ms. Furthermore, anti-tachycardia pacing (ATP) is well known to safely terminate organized arrhythmias but no data are available on ATP efficacy in the setting of prolonged arrhythmia detection. We assessed ATP efficacy in the ADVANCEIII population.
Methods: We analyzed 1902 patients enrolled in the ADVANCEIII Study on a median 12 month follow up: 948 patients randomized to a long detection settings (NID 30/40) and 954 to a short setting (NID 18/24). ATP during capacitor charge was programmed on in all patients. Secondary prevention was ICD indication for 25% of the cases. All arrhythmic episodes were reviewed by an independent blinded committee. ATP success was compared between study arms by means of a logistic model adjusted with a random effect for patient to account for multiple episodes per patient.
Results: There were 125 episodes treated with ATP in the 18/24 arm and 204 in the 30/40 arm. ATP successfully terminated 55.8% of the episodes in the NID 18/24 arm and 44.0% in the NID 30/40 (OR: 0.38 CI: 0.14 - 1.02 p=0.054). Details on ATP efficacy based on patient’s prevention are showed in table 1.
Conclusions: This analysis shows that in prolonged arrhythmia detection ATP efficacy was still as high as 44%. Thus, our results suggest that the maximum reduction in unnecessary ICD shocks can be obtained with a long detection setting together with the use of ATP during charging. Trial Registration: ClinicalTrials.gov Identifier: NCT00617175
- © 2012 by American Heart Association, Inc.