1. Patient‐by‐patient basis anti‐tachycardia pacing for fast ventricular tachycardia with structural heart diseases
- Author
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Takashi Noda, Masaomi Chinushi, Yoshifusa Aizawa, Osamu Saitoh, Takashi Kurita, Takashi Nitta, Tohru Ohe, and Hiroshi Furushima
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Heart Diseases ,Electric Countershock ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Amiodarone ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Heart rate ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Ejection fraction ,Receiver operating characteristic ,business.industry ,Cardiac Pacing, Artificial ,General Medicine ,medicine.disease ,Defibrillators, Implantable ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Anti-tachycardia pacing (ATP) delivered from an implantable device is an important tool to terminate ventricular tachycardia (VT). But its real-world efficacy for fast VT has not been fully studied. Methods Using the database of Nippon-storm study, effect of patient-by-patient basis ATP programming for fast VT (≥188 bpm) was assessed for the patients with structural heart diseases. Fast VTs were divided into three groups depending on heart rate (HR); Group A was 188-209 bpm, and Group-B and Group-C were 210-239 bpm and ≥240 bpm, respectively. Results During a median follow-up of 28 months, 202 fast VT episodes (209 ± 19 bpm) were demonstrated in the 85 patients. ATP terminated 151 of the 202 episodes (74.8%) in total. The success rate of the ATP was not different among the three groups: 73.3% in Group A, 80.6% in Group B, and 66.7% in Group C. ATP success rate of >50% and >70% was 77.6% and 64.7% of the patients, respectively. Left ventricular ejection fraction (LVEF) was significantly higher in the patients with rather than without successful ATP therapy, and receiver operating characteristic (ROC) analysis revealed that LVEF of 23% was the optimal cut-off value. ATP was less effective in patients taking amiodarone, but etiology of the structural heart diseases, indication of the device implantation, and all Electrocardiogram (ECG) parameters were not useful predictors for successful ATP therapy. Conclusions ATP highly terminated fast VT with wide HR ranges in patients with structural heart diseases, and should be considered as the first-line therapy for fast VT except for patients with very low LVEF.
- Published
- 2020