Optimizing implantable cardioverter-defibrillator treatment of rapid ventricular tachycardia: Antitachycardia pacing therapy during charging

Schoels, Wolfgang; Steinhaus, David; Johnson, W. Ben; O’Hara, Gilles; Schwab, Joerg O.; Jenniskens, Inge; DeGroot, Paul; Tang, Feng; Helmling, Erhard

doi:10.1016/j.hrthm.2007.03.008

Cited by 52 publications

(42 citation statements)

References 15 publications

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“…This is consistent with previous studies showing that dedicated ATP programming reduce the need for shocks to terminate VT/VF in a substantial number of patients [7,17,23]. In addition, newer devices are able to deliver ATP during energy charge when treating a VF episode, in an attempt to terminate a fast VT detected in the VF zone [24,25]. Interestingly, we observed no first shock failures following ineffective ATP therapies, both in DT+ and DTpatients, since all first shocks were programmed at maximum energy [23].…”

Section: Icd Therapy Efficacy In Dt+ Vs Dtpatientssupporting

confidence: 91%

“…Patients in the DT+ group were followed for a longer period than DT-patients (32 vs. 15 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] months; p < 0.001). After adjusting the event rate by the follow-up duration, there was no significant difference in the death rate per observation year (DT+: 0.04 vs. DT-: 0.04; p = 0.91) nor in the rate of patients with ventricular arrhythmic events per observation year (DT+: 0.10 vs. DT-: 0.12; p = 0.46) ( Table 2).…”

Section: Patients' Clinical Outcomesmentioning

confidence: 99%

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Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

et al. 2015

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Section: Icd Therapy Efficacy In Dt+ Vs Dtpatientssupporting

confidence: 91%

Section: Patients' Clinical Outcomesmentioning

confidence: 99%

Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

et al. 2015

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“…Second, because shock confirmation after charging is less specific than the VT redetection after ATP, shocks are delivered after Ϸ5% of successful ATP sequences. 46,47 We believe that programming appropriate rate zones and different therapies for slow and faster ventricular arrhythmias would provide similar clinical benefit as ATP during charging. Nevertheless, if one decides to program ATP before shock delivery in faster 41 The pie charts show terminating therapy for FVT episodes in each arm.…”

Section: Therapy and Therapy-zone Boundariesmentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

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“…of ventricular arrhythmia events in repaired TOF patients. 2 Schoels et al showed that ATP could significantly terminate monomorphic VT more often than polymorphic VT. 17 Tuan et al showed that a smaller morphological variation, which means monomorphic VT, correlated with a higher probability of a successful ATP. 18 In the present study, >70% of the patients had β-blockers, and more than 40% of the patients had either amiodarone or sotalol.…”

Section: Overall Survivalmentioning

confidence: 99%

Long-Term Efficacy of Implantable Cardioverter Defibrillator in Repaired Tetralogy of Fallot　― Role of Anti-tachycardia Pacing ―

Henmi

Ejima

Daigo

et al. 2017

Circ J

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Optimizing implantable cardioverter-defibrillator treatment of rapid ventricular tachycardia: Antitachycardia pacing therapy during charging

Cited by 52 publications

References 15 publications

Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Long-Term Efficacy of Implantable Cardioverter Defibrillator in Repaired Tetralogy of Fallot　― Role of Anti-tachycardia Pacing ―

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Optimizing implantable cardioverter-defibrillator treatment of rapid ventricular tachycardia: Antitachycardia pacing therapy during charging

Cited by 52 publications

References 15 publications

Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Long-Term Efficacy of Implantable Cardioverter Defibrillator in Repaired Tetralogy of Fallot ― Role of Anti-tachycardia Pacing ―

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Long-Term Efficacy of Implantable Cardioverter Defibrillator in Repaired Tetralogy of Fallot　― Role of Anti-tachycardia Pacing ―