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Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator

BACKGROUND: Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD sho...

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Autores principales: Awad, Sherien Samy, Azeez, Emmanuel Fares, Taha, Mohamed Ossama, El-Naggar, Wael Mohamed, El-Damaty, Ahmed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236081/
https://www.ncbi.nlm.nih.gov/pubmed/37266828
http://dx.doi.org/10.1186/s43044-023-00369-y
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author Awad, Sherien Samy
Azeez, Emmanuel Fares
Taha, Mohamed Ossama
El-Naggar, Wael Mohamed
El-Damaty, Ahmed
author_facet Awad, Sherien Samy
Azeez, Emmanuel Fares
Taha, Mohamed Ossama
El-Naggar, Wael Mohamed
El-Damaty, Ahmed
author_sort Awad, Sherien Samy
collection PubMed
description BACKGROUND: Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD shocks. The aim of this study was to investigate the predictors of VT acceleration by ATP therapy in a real-life patient cohort. RESULTS: We retrospectively reviewed 448 monomorphic VT episodes that required ATP therapy in 60 patients with structural heart diseases implanted with ICD or CRTD. The clinical data of the patients and the episodes’ details were evaluated. We found that patients with a higher ejection fraction (EF) were more likely to be cardioverted by ATP therapy (P: 0.024). VT acceleration was more frequent in patients with lower EF (mean 31.24 ± 4.08) compared with the non-accelerated patients with higher EF (mean 37.00 ± 9.4, P: 0.016). The percentage of accelerated episodes was 8.5%. VT episodes with a mean cycle length (CL) < 310 ms are more likely to accelerate (sensitivity 76.3%, specificity 67.7%, PPV value 45%, NPV 86%, and AUC 0.790). There was a statistically significant difference in the accelerated VT episodes as compared to non-accelerated episodes regarding the number of ATP bursts (mean 3.66 ± 2.22 vs. 1.76 ± 1.35, P: < 0.001), ramp (23.7% vs. 4.2%, P: < 0.001), scanning (55.3% vs. 31.3%, P: 0.003) and burst adaptive cycle length (mean 83.55 ± 2.92 vs. 84.64 ± 2.61, P: 0.016). In a multivariate analysis, the VT CL, number of ATP bursts and ramp pacing predicted VT acceleration by ATP therapy. CONCLUSIONS: Ventricular tachycardia in patients with low LV EF and fast VTs with a CL less than 310 ms were more likely to accelerate with ATP therapy. The number of ATP bursts and the use of ramp had a significant effect on VT acceleration. To avoid VT acceleration by ATP therapy, ramp pacing better be avoided, especially in fast VTs, and lesser number of bursts should be delivered.
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spelling pubmed-102360812023-06-03 Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator Awad, Sherien Samy Azeez, Emmanuel Fares Taha, Mohamed Ossama El-Naggar, Wael Mohamed El-Damaty, Ahmed Egypt Heart J Research BACKGROUND: Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD shocks. The aim of this study was to investigate the predictors of VT acceleration by ATP therapy in a real-life patient cohort. RESULTS: We retrospectively reviewed 448 monomorphic VT episodes that required ATP therapy in 60 patients with structural heart diseases implanted with ICD or CRTD. The clinical data of the patients and the episodes’ details were evaluated. We found that patients with a higher ejection fraction (EF) were more likely to be cardioverted by ATP therapy (P: 0.024). VT acceleration was more frequent in patients with lower EF (mean 31.24 ± 4.08) compared with the non-accelerated patients with higher EF (mean 37.00 ± 9.4, P: 0.016). The percentage of accelerated episodes was 8.5%. VT episodes with a mean cycle length (CL) < 310 ms are more likely to accelerate (sensitivity 76.3%, specificity 67.7%, PPV value 45%, NPV 86%, and AUC 0.790). There was a statistically significant difference in the accelerated VT episodes as compared to non-accelerated episodes regarding the number of ATP bursts (mean 3.66 ± 2.22 vs. 1.76 ± 1.35, P: < 0.001), ramp (23.7% vs. 4.2%, P: < 0.001), scanning (55.3% vs. 31.3%, P: 0.003) and burst adaptive cycle length (mean 83.55 ± 2.92 vs. 84.64 ± 2.61, P: 0.016). In a multivariate analysis, the VT CL, number of ATP bursts and ramp pacing predicted VT acceleration by ATP therapy. CONCLUSIONS: Ventricular tachycardia in patients with low LV EF and fast VTs with a CL less than 310 ms were more likely to accelerate with ATP therapy. The number of ATP bursts and the use of ramp had a significant effect on VT acceleration. To avoid VT acceleration by ATP therapy, ramp pacing better be avoided, especially in fast VTs, and lesser number of bursts should be delivered. Springer Berlin Heidelberg 2023-06-02 /pmc/articles/PMC10236081/ /pubmed/37266828 http://dx.doi.org/10.1186/s43044-023-00369-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Awad, Sherien Samy
Azeez, Emmanuel Fares
Taha, Mohamed Ossama
El-Naggar, Wael Mohamed
El-Damaty, Ahmed
Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title_full Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title_fullStr Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title_full_unstemmed Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title_short Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
title_sort arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236081/
https://www.ncbi.nlm.nih.gov/pubmed/37266828
http://dx.doi.org/10.1186/s43044-023-00369-y
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