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

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



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.


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).


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).


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.


Implantable cardiac defibrillator Ventricular tachycardia Antitachycardia pacing Shock 



implantable cardioverter-defibrillator


primary prevention


secondary prevention


monomorphic ventricular tachycardia


antitachycardia pacing


left ventricular ejection fraction


cycle length


percentage of variation of R-R intervals


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


non-sustained ventricular tachyarrhythmia


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.PubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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. 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.CrossRefPubMedGoogle Scholar
  8. 8.
    Hutchinson, T. A., & Shahan, T. R. (2002). DRUGDEXH system. Greenwood Village: MICROMEDEX.Google Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 13.
    Liang, K., & Zeger, S. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13–22.CrossRefGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 18.
    Sweeney, M. O. (2004). Antitachycardia pacing for ventricular tachycardia using implantable cardioverter defibrillators. Pacing and Clinical Electrophysiology, 27(9), 1292–1305.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Javier Jiménez-Candil
    • 1
  • Jesús Hernández
    • 1
  • Ana Martín
    • 1
  • José Moríñigo
    • 1
  • Pedro Perdiguero
    • 1
  • Loreto Bravo
    • 1
  • Sonia Ruiz
    • 1
  • Pedro L Sánchez
    • 1
  1. 1.Cardiology Department, Biomedical Research Institute of Salamanca (IBSAL)University HospitalSalamancaSpain

Personalised recommendations