Abstract 17375: Anti-tachycardia Pacing Success for Fast Arrhythmias in the Settings of a Prolonged Detection. Data From the AdvanceIII Trial
Purpose: ADVANCEIII trial demonstrated that a prolonged detection strategy combined with anti-tachycardia pacing (ATP) reduces significantly the overall Implantable Cardioverter Defibrillator (ICD) therapies and inappropriate ICD shocks. We aimed to determine the efficacy of ATP to terminate fast arrhythmic episodes in the ADVANCEIII arms.
Methods: A total of 1902 patients with standard ICD or CRTD indications were randomized to be programmed with a number of intervals to detect (NID) 30/40 or 18/24. All devices were programmed with ATP During Charging before shocks for episodes with cycle lengths (CL) between 200 and 320ms and shock only for episodes with CL<200ms. Both primary and secondary prevention indication pts were included. All arrhythmic episodes were reviewed by an independent committee.
Results: During a mean follow up of 12 months, 294 ventricular episodes with mean CL between 320ms and 240ms were appropriately treated with at least an ATP in 154 patients ( 178 in 99 patients in the control arm vs 116 in 55 in the long detection, IRR 0.68 (0.450-1.02), p=0.60). ATP had an overall efficacy of 58% with no observed difference between NID settings (p=0.191) (table 1). No difference in the number of delivered shocks was observed (IRR 0.86 (0.50-1.48), p=0.579) (fig 1).
For 57 fast arrhythmic episodes (200 ms≤CL≤240 ms), ATP successfully terminated 37% (21 episodes in 8 patients).
Conclusions: ATP during charging with a prolonged detection not only reduced the overall ICD therapies and inappropriate shocks but also avoided an appropriate shock in 54% of the sustained episodes with cycle length between 240ms and 320 ms Table 1: ATP success by NID
Fig 1: Therapies distribution by NID
- © 2013 by American Heart Association, Inc.