Impact of device programming on the success of the first anti-tachycardia pacing therapy: An anonymized large-scale study

TY - JOUR

T1 - Impact of device programming on the success of the first anti-tachycardia pacing therapy

T2 - An anonymized large-scale study

AU - Shakibfar, Saeed

AU - Krause, Oswin

AU - Lund-Andersen, Casper

AU - Strycko, Filip

AU - Moll, Jonas

AU - Osman Andersen, Tariq

AU - Høgh Petersen, Helen

AU - Hastrup Svendsen, Jesper

AU - Igel, Christian

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background Antitachycardia pacing (ATP) is an effective treatment for ventricular tachycardia (VT). We evaluated the efficacy of different ATP programs based on a large remote monitoring data set from patients with implantable cardioverter-defibrillators (ICDs). Methods A dataset from 18,679 ICD patients was used to evaluate the first delivered ATP treatment. We considered all device programs that were used for at least 50 patients, leaving us with 7 different programs and a total of 32,045 episodes. We used the two-proportions z-test (α = 0.01) to compare the probability of success and the probability for acceleration in each group with the corresponding values of the default setting. Results Overall, the first ATP treatment terminated in 78.4%–97.5% of episodes with slow VT and 81.5%–91.1% of episodes with fast VT. The default setting of the ATP programs with the number of sequences S = 3 was applied to treat 30.1% of the slow and 36.6% of the fast episodes. Reducing the maximum number of sequences to S = 2 decreased the success rate for slow VT (P < 0.0001, h = 0.38), while the setting S = 4 resulted in the highest success rate of 97.5% (P < 0.0001, h = 0.27). Conclusion While the default programs performed well, we found that increasing the number of sequences from 3 to 4 was a promising option to improve the overall ATP performance.

AB - Background Antitachycardia pacing (ATP) is an effective treatment for ventricular tachycardia (VT). We evaluated the efficacy of different ATP programs based on a large remote monitoring data set from patients with implantable cardioverter-defibrillators (ICDs). Methods A dataset from 18,679 ICD patients was used to evaluate the first delivered ATP treatment. We considered all device programs that were used for at least 50 patients, leaving us with 7 different programs and a total of 32,045 episodes. We used the two-proportions z-test (α = 0.01) to compare the probability of success and the probability for acceleration in each group with the corresponding values of the default setting. Results Overall, the first ATP treatment terminated in 78.4%–97.5% of episodes with slow VT and 81.5%–91.1% of episodes with fast VT. The default setting of the ATP programs with the number of sequences S = 3 was applied to treat 30.1% of the slow and 36.6% of the fast episodes. Reducing the maximum number of sequences to S = 2 decreased the success rate for slow VT (P < 0.0001, h = 0.38), while the setting S = 4 resulted in the highest success rate of 97.5% (P < 0.0001, h = 0.27). Conclusion While the default programs performed well, we found that increasing the number of sequences from 3 to 4 was a promising option to improve the overall ATP performance.

U2 - 10.1371/journal.pone.0219533

DO - 10.1371/journal.pone.0219533

M3 - Journal article

C2 - 31393871

SN - 1932-6203

VL - 14

JO - PLoS ONE

JF - PLoS ONE

IS - 8

M1 - e0219533

ER -