Skip to main content
SpringerLink
Log in

Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether monomorphic ventricular tachycardias (VTs) have different characteristics and/or responses to antitachycardia pacing (ATP) with respect to the indication—primary prevention (PP) versus secondary prevention (SP)—among ICD patients with left ventricular dysfunction.

Methods

We prospectively studied 551 VT (cycle length [CL] 329 ± 35 ms; PP 34 %) occurring in 67 ICD patients with left ventricular dysfunction (LVEF 35 ± 8 %). ICD programming was standardized, including ATP for slow (CL 400–321 ms) and fast VT (CL 250–320 ms). We analyzed the following aspects: CL, percentage of variability of the 12 RR intervals prior to ATP (P-RR)—which was calculated by dividing the mean difference between each R-R interval with the next one by the CL × 100—and type of termination: immediate (VT ceased immediately upon ATP completion) or delayed (VT persisted after ATP).

Results

ATP was successful in 86 % of VTs. VTs occurring in SP patients had a lower P-RR, median (IQR) 2.7 % (1.2–3.7) versus 1.9 % (0.9–3.2); p = 0.002; they terminated immediately after ATP less frequently (27 % versus 12 %; p < 0.001), and although they were more frequently slow (51 % versus 67 %; p = 0.01), ATP was less effective in them, 92 versus 80 % (p = 0.02).

Conclusions

VTs occurring in SP patients are slower, more stable, and they terminate less frequently at ATP. Therefore, compared with PP, SP patients seem to have fewer self-terminating VTs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ICD:

implantable cardioverter-defibrillator

PP:

primary prevention

SP:

secondary prevention

VT:

monomorphic ventricular tachycardia

ATP:

antitachycardia pacing

LVEF:

left ventricular ejection fraction

CL:

cycle length

P-RR:

percentage of variation of R-R intervals

Mn-RR:

mean difference between each R-R interval with the next one

NSVT:

non-sustained ventricular tachyarrhythmia

References

  1. Moss, A. J., Zareba, W., Hall, W. J., Klein, H., Wilber, D. J., Cannom, D. S., et al. (2002). Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. New England Journal of Medicine, 346(12), 877–883.

    Article  PubMed  Google Scholar 

  2. Daubert, J. P., Zareba, W., Cannom, D. S., McNitt, S., Rosero, S. Z., Wang, P., et al. (2008). Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. Journal of the American College of Cardiology, 51(14), 1357–1365.

    Article  PubMed  Google Scholar 

  3. Moss, A. J., Schuger, C., & Daubert, J. P. (2013). A clinical trial of ICD programming. New England Journal of Medicine, 368(10), 965–966.

    CAS  PubMed  Google Scholar 

  4. Wathen, M. S., DeGroot, P. J., Sweeney, M. O., Stark, A. J., Otterness, M. F., Adkisson, W. O., et al. (2004). Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: pacing fast ventricular tachycardia reduces shock therapies (PainFREE Rx II) trial results. Circulation, 110(17), 2591–2596.

    Article  PubMed  Google Scholar 

  5. Callans, D. J., & Josephson, M. E. (2004). Ventricular tachycardia in patients with coronary artery disease. In D. P. Zipes (Ed.), Cardiac electrophysiology. From cell to bedside (pp. 569–574). Sauders: Phipaldelphia.

    Chapter  Google Scholar 

  6. Josephson, M. E. (2008). Recurrent ventricular tachycardia. In M. E. Josephson (Ed.), Clinical cardiac electrophysiology. Techniques and interpretations (pp. 530–531). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  7. Jimenez-Candil, J., Ruiz, M., Herrero, J., Leon, V., Martin, A., Morinigo, J., et al. (2010). Relationship between the duration of the basal QRS complex and electrical therapies for ventricular tachycardias among ICD patients. Pacing and Clinical Electrophysiology, 33(5), 596–604.

    Article  PubMed  Google Scholar 

  8. Hutchinson, T. A., & Shahan, T. R. (2002). DRUGDEXH system. Greenwood Village: MICROMEDEX.

    Google Scholar 

  9. Jimenez-Candil, J., Arenal, A., Garcia-Alberola, A., Ortiz, M., del Castillo, S., Fernandez-Portales, J., et al. (2005). Fast ventricular tachycardias in patients with implantable cardioverter-defibrillators: efficacy and safety of antitachycardia pacing. A prospective and randomized study. Journal of the American College of Cardiology, 45(3), 460–461.

    Article  PubMed  Google Scholar 

  10. Garcia-Alberola, A., Yli-Mayry, S., Block, M., Haverkamp, W., Martinez-Rubio, A., Kottkamp, H., et al. (1996). RR interval variability in irregular monomorphic ventricular tachycardia and atrial fibrillation. Circulation, 93(2), 295–300.

    Article  CAS  PubMed  Google Scholar 

  11. Swerdlow, C. D., Chen, P. S., Kass, R. M., Allard, J. R., & Peter, C. T. (1994). Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. Journal of the American College of Cardiology, 23(6), 1342–1355.

    Article  CAS  PubMed  Google Scholar 

  12. Aliot, E. M., Stevenson, W. G., Almendral-Garrote, J. M., Bogun, F., Calkins, C. H., Delacretaz, E., et al. (2009). EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the european heart rhythm association (EHRA), a registered branch of the european society of cardiology (ESC), and the heart rhythm society (HRS); in collaboration with the american college of cardiology (ACC) and the american heart association (AHA). Europace, 11(6), 771–817.

    Article  PubMed  Google Scholar 

  13. Liang, K., & Zeger, S. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13–22.

    Article  Google Scholar 

  14. Jimenez-Candil, J., Hernandez, J., Martin, A., Ruiz-Olgado, M., Herrero, J., Ledesma, C., et al. (2010). Influence of beta-blocker therapy on antitachycardia pacing effectiveness for monomorphic ventricular tachycardias occurring in implantable cardioverter-defibrillator patients: a dose-dependent effect. Europace, 12(9), 1231–1238.

    Article  PubMed  Google Scholar 

  15. Sweeney, M. O., Sherfesee, L., DeGroot, P. J., Wathen, M. S., & Wilkoff, B. L. (2010). Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm, 7(3), 353–360.

    Article  PubMed  Google Scholar 

  16. Jimenez-Candil, J., Anguera, I., Ledesma, C., Fernandez-Portales, J., Morinigo, J. L., Dallaglio, P., et al. (2013). Morphology of far-field electrograms and antitachycardia pacing effectiveness among fast ventricular tachycardias occurring in ICD patients: a multicenter study. Journal of Cardiovascular Electrophysiology, 24(12), 1375–1382.

    Article  PubMed  Google Scholar 

  17. Peinado, R., Almendral, J., Rius, T., Moya, A., Merino, J. L., Martinez-Alday, J., et al. (1998). Randomized, prospective comparison of four burst pacing algorithms for spontaneous ventricular tachycardia. American Journal of Cardiology, 82(11), 1422–1425. A1428-1429.

    Article  CAS  PubMed  Google Scholar 

  18. Sweeney, M. O. (2004). Antitachycardia pacing for ventricular tachycardia using implantable cardioverter defibrillators. Pacing and Clinical Electrophysiology, 27(9), 1292–1305.

    Article  PubMed  Google Scholar 

  19. Zhou, X., Gunderson, B. D., & Olson, W. H. (2004). Incidence of nonsustained and sustained ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator. Journal of Cardiovascular Electrophysiology, 15(1), 14–20.

    Article  PubMed  Google Scholar 

  20. Gulizia, M. M., Piraino, L., Scherillo, M., Puntrello, C., Vasco, C., Scianaro, M. C., et al. (2009). A randomized study to compare ramp versus burst antitachycardia pacing therapies to treat fast ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators: the PITAGORA ICD trial. Circulation. Arrhythmia and Electrophysiology, 2(2), 146–153.

    Article  PubMed  Google Scholar 

  21. Marchlinski, F. E. (1987). Characterization of oscillations in ventricular refractoriness in man after an abrupt increment in heart rate. Circulation, 75(3), 550–556.

    Article  CAS  PubMed  Google Scholar 

  22. Jimenez-Candil, J., Hernandez, J., Martin, A., Morinigo, J., Lopez, R., Ledesma, C., et al. (2013). Influence of cycle length variations on antitachycardia pacing effectiveness among ICD patients. Heart Rhythm, 10(2), 207–213.

    Article  PubMed  Google Scholar 

  23. Sharma, V., DeGroot, P. J., & Wathen, M. S. (2003). Incidence and characteristics of type-2 breaks in response to antitachycardia pacing therapy in implantable cardioverter defibrillator patients. Journal of Cardiovascular Electrophysiology, 14(11), 1156–1162.

    Article  PubMed  Google Scholar 

  24. Gasparini, M., Proclemer, A., Klersy, C., Kloppe, A., Lunati, M., Ferrer, J. B., et al. (2013). Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA, 309(18), 1903–1911.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Cardiology Department, Biomedical Research Institute of Salamanca (IBSAL), University Hospital, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain

    Javier Jiménez-Candil, Jesús Hernández, Ana Martín, José Moríñigo, Pedro Perdiguero, Loreto Bravo, Sonia Ruiz & Pedro L Sánchez

Authors
  1. Javier Jiménez-Candil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesús Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. José Moríñigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pedro Perdiguero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Loreto Bravo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sonia Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pedro L Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Javier Jiménez-Candil.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiménez-Candil, J., Hernández, J., Martín, A. et al. Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms. J Interv Card Electrophysiol 44, 187–195 (2015). https://doi.org/10.1007/s10840-015-0050-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0050-0

Keywords

Search

Navigation