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Antitachycardia Pacing Therapy

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Giuseppe Boriani – One of the best experts on this subject based on the ideXlab platform.

  • Reactive atrial-based Antitachycardia Pacing Therapy reduces atrial tachyarrhythmias.
    Pacing and clinical electrophysiology : PACE, 2019
    Co-Authors: George H. Crossley, Luigi Padeletti, Steven Zweibel, J. Harrison Hudnall, Yan Zhang, Giuseppe Boriani
    Abstract:

    BACKGROUND Reactive atrial-based Antitachycardia Pacing (rATP) aims to terminate atrial tachyarrhythmia/atrial fibrillation (AT/AF) episodes when they spontaneously organize to atrial flutter or atrial tachtachycardia; however, its effectiveness in the real-world has not been studied. We used a large device database (Medtronic CareLink, Medtronic, Minneapolis, MN, USA) to evaluate the effects of rATP at reducing AT/AF. METHODS Pacemaker, defibrillator, and resynchronization device transmission data were analyzed. Eligible patients had device detected AT/AF during a baseline period but were not in persistent AT/AF immediately preceding first transmission. Note that 1:1 individual matching between groups was conducted using age, sex, device type, Pacing mode, AT/AF, and percent ventricular Pacing at baseline. Risks of AT/AF events were compared between patients with rATP-enabled versus control patients with rATP-disabled or not available in the device. For matched patients, AT/AF event rates at 2 years were estimated by Kaplan-Meier method, and hazard ratios (HRs) were calculated by Cox proportional hazard models. RESULTS Of 43,440 qualifying patients, 4,203 had rATP on. Matching resulted in 4,016 pairs, totaling 8,032 patients for analysis. The rATP group experienced significantly lower risks of AT/AF events lasting ≥1 day (HR 0.81), ≥7 days (HR 0.64), and ≥30 days (HR 0.56) compared to control (P 

  • Ventricular Antitachycardia Pacing Therapy in patients with heart failure implanted with a cardiac resynchronization Therapy defibrillator device: Efficacy, safety, and impact on mortality.
    Heart rhythm, 2015
    Co-Authors: Maurizio Landolina, Giuseppe Boriani, Renato Pietro Ricci, Maurizio Lunati, Alessandro Proclemer, Domenico Facchin, Roberto Rordorf, Giovanni Morani, Massimiliano Maines, Gianni Gasparini
    Abstract:

    Background Cardiac resynchronization Therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via Antitachycardia Pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization Therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP Therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%–69%) on FVTs and 68% (95% CI 62%–74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP Therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3–7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4–6.1) in patients with inappropriate ATP (P = .045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

  • Antitachycardia Pacing Therapy to treat spontaneous atrial tachyarrhythmias: the 7250 Dual Defibrillator Italian Registry
    European Heart Journal Supplements, 2001
    Co-Authors: Renato Pietro Ricci, Giuseppe Boriani, Luigi Padeletti, Carlo Pignalberi, Disertori M, Alessandro Capucci, G.l. Botto, F. Miraglia, T De Santo, Massimo Santini
    Abstract:

    Background The dual defibrillator is a new device that can deliver atrial Antitachycardia Pacing (ATP) and shock therapies to treat atrial tachyarrhythmias in patients with and without life-threatening ventricular tachyarrhythmias. The aims of the present study were to investigate the efficacy of ATP and to identify factors that may impact on success of treatment. Method A total of 105 patients (80 male, mean age 64 ± 10 years) implanted with a dual defibrillator were enrolled in the study; 66% had documented atrial fibrillation (AF) before implantation a nd 14% had no history of prior ventricular tachyarrhythmias.

Jeffrey J. Goldberger – One of the best experts on this subject based on the ideXlab platform.

  • Predictors of appropriate implantable cardioverter-defibrillator Therapy in patients with idiopathic dilated cardiomyopathy.
    The American journal of cardiology, 2002
    Co-Authors: Vladimir Rankovic, Juhana Karha, Rod S. Passman, Alan H. Kadish, Jeffrey J. Goldberger
    Abstract:

    Abstract Evaluating predictors of appropriate implantable cardioverter-defibrillator (ICD) Therapy in patients with idiopathic dilated cardiomyopathy (IDC) may be helpful in developing risk stratification strategies for these patients. Fifty-four patients with IDC underwent ICD implantation and were followed up. Twenty-three patients (42%) had a class I indication for ICD implantation; the remaining patients underwent implantation for multiple risk factors for sudden death including left ventricular dysfunction, nonsustained ventricular tachycardia, syncope, or positive electrophysiologic study results. Clinical, electrocardiographic, and electrophysiologic data were collected. Appropriate ICD Therapy was defined as an Antitachycardia Pacing Therapy or shock for tachyarrhythmia determined to be either ventricular tachycardia or ventricular fibrfibrillation. Appropriate ICD Therapy was observed in 23 patients (42%). There was a significant difference in use of β-blocker Therapy between patients who did and did not have appropriate ICD Therapy (p

Renato Pietro Ricci – One of the best experts on this subject based on the ideXlab platform.

  • Ventricular Antitachycardia Pacing Therapy in patients with heart failure implanted with a cardiac resynchronization Therapy defibrillator device: Efficacy, safety, and impact on mortality.
    Heart rhythm, 2015
    Co-Authors: Maurizio Landolina, Giuseppe Boriani, Renato Pietro Ricci, Maurizio Lunati, Alessandro Proclemer, Domenico Facchin, Roberto Rordorf, Giovanni Morani, Massimiliano Maines, Gianni Gasparini
    Abstract:

    Background Cardiac resynchronization Therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via Antitachycardia Pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization Therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP Therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%–69%) on FVTs and 68% (95% CI 62%–74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP Therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3–7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4–6.1) in patients with inappropriate ATP (P = .045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

  • Antitachycardia Pacing Therapy to treat spontaneous atrial tachyarrhythmias: the 7250 Dual Defibrillator Italian Registry
    European Heart Journal Supplements, 2001
    Co-Authors: Renato Pietro Ricci, Giuseppe Boriani, Luigi Padeletti, Carlo Pignalberi, Disertori M, Alessandro Capucci, G.l. Botto, F. Miraglia, T De Santo, Massimo Santini
    Abstract:

    Background The dual defibrillator is a new device that can deliver atrial Antitachycardia Pacing (ATP) and shock therapies to treat atrial tachyarrhythmias in patients with and without life-threatening ventricular tachyarrhythmias. The aims of the present study were to investigate the efficacy of ATP and to identify factors that may impact on success of treatment. Method A total of 105 patients (80 male, mean age 64 ± 10 years) implanted with a dual defibrillator were enrolled in the study; 66% had documented atrial fibrillation (AF) before implantation a nd 14% had no history of prior ventricular tachyarrhythmias.

Gianni Gasparini – One of the best experts on this subject based on the ideXlab platform.

  • Ventricular Antitachycardia Pacing Therapy in patients with heart failure implanted with a cardiac resynchronization Therapy defibrillator device: Efficacy, safety, and impact on mortality.
    Heart rhythm, 2015
    Co-Authors: Maurizio Landolina, Giuseppe Boriani, Renato Pietro Ricci, Maurizio Lunati, Alessandro Proclemer, Domenico Facchin, Roberto Rordorf, Giovanni Morani, Massimiliano Maines, Gianni Gasparini
    Abstract:

    Background Cardiac resynchronization Therapy defibrillator can terminate ventricular tachycardia (VT) and fast VT (FVT) via Antitachycardia Pacing (ATP). Objectives We evaluated efficacy and safety of ATP, whether ATP induces ventricular arrhythmias after inappropriate ATP or atrial fibrillation (AF) after appropriate ATP, and whether ATP is associated with mortality. Methods A total of 1404 patients with a cardiac resynchronization Therapy defibrillator were followed in a prospective multicenter observational research. All-cause mortality rates were estimated in patient subgroups in order to uncouple the trigger (VT/FVT or other rhythms causing inappropriate detections) from ATP Therapy. Results Over a median follow-up of 31 months, 2938 VT/FVT episodes were treated with ATP in 360 patients. The adjusted ATP success rate was 63% (95% confidence interval [CI] 57%–69%) on FVTs and 68% (95% CI 62%–74%) on VTs. Acceleration occurred in 55 (1.87%) and syncope in 4 (0.14%) of all ATP-treated episodes. In 14 true VT/FVT episodes in 5 patients, AF followed ATP Therapy. In 4 episodes in 2 patients, VT followed ATP inappropriately applied during AF. Death rate per 100 patient-years was 5.6 (95% CI 4.3–7.5) in patients with appropriate ATP and 1.5 (95% CI 0.4–6.1) in patients with inappropriate ATP (P = .045). Conclusion ATP was effective in terminating VT/FVT episodes and displayed a good safety profile. ATP therapies by themselves did not increase death risk; prognosis was indeed better in patients without arrhythmic episodes, even if they received inappropriate ATP, than in patients with ATP on VT/FVT episodes. Adverse outcomes observed in patients receiving implantable cardioverter-defibrillator therapies are probably related to the arrhythmia itself, a marker of disease progression, rather than to adverse effects of ATP.

Anne M. Gillis – One of the best experts on this subject based on the ideXlab platform.

  • Pacemakers, implantable cardioverter/defibrillators, and extracorporeal shockwave lithotripsy: evidence-based guidelines for the modern era.
    Journal of endourology, 2008
    Co-Authors: Michael Platonov, Anne M. Gillis, Katherine M. Kavanagh
    Abstract:

    Early work examining interactions between extracorporeal shockwave lithotripsy (SWL) and implantable pacemakers or implantable cardioverter/defibrillators suggested that shockwave oversensing may result in inappropriate suppression of Pacing, delivery of Antitachycardia Pacing Therapy, delivery of inappropriate shock Therapy, or outright damage to such devices. In the absence of national guidelines, those provided by manufacturers are nonuniform and practice patterns vary between centers. Improvements in SWL energy delivery as well as in device shielding and discrimination technologies have demonstrated improved safety data in recent years. We review these advances in both technologies as well as the most recent data to construct practice guidelines for the modern era.

  • high atrial Antitachycardia Pacing Therapy efficacy is associated with a reduction in atrial tachyarrhythmia burden in a subset of patients with sinus node dysfunction and paroxysmal atrial fibrillation
    Heart Rhythm, 2005
    Co-Authors: Anne M. Gillis, Jodi Koehler, Margaret Morck, Rahul Mehra, Douglas A Hettrick
    Abstract:

    Background Atrial tachtachycardia (AT) and atrial flutter that occur in association with paroxysmal atrial fibrfibrillation (AF) can be successfully terminated by Antitachycardia Pacing (ATP) Therapy. We hypothesized that atrial ATP Therapy reduces AT/AF burden in a subset of patients with symptomatic bradycardia and frequent paroxysmal AT/AF. Objectives This study evaluated the effect of atrial ATP Therapy on AT/AF burden in a pacemaker population with paroxysmal AF. Methods We compared AT/AF burden in 261 patients who received a Medtronic AT500 pacemaker for treatment of AT/AF in the setting of symptomatic bradycardia based on device-classified atrial ATP efficacy Results The high efficacy group comprised 75 patients with atrial ATP efficacy ≥60%. The low efficacy group comprised 186 patients with atrial ATP efficacy P = .01). In contrast, total AT/AF burden decreased significantly in the high efficacy group (median 2.46 [0.29–8.88] hours/day vs 0.68 [0.13–2.97] hours/day, P Conclusion Up to 30% of patients with frequent episodes of paroxysmal AF and symptomatic bradycardia experience a reduction in AT/AF burden from atrial ATP Therapy over time.

  • Atrial Pacing Therapies for Prevention of Atrial Fibrillation in Patients with Implantable Defibrillators
    Cardiac Electrophysiology Review, 2003
    Co-Authors: Anne M. Gillis
    Abstract:

    Atrial fibrillation (AF), atrial flutter and atrial tachtachycardia (AT) occur frequently in patients following implantation of an implantable cardioverter defibrillator (ICD) for the treatment of ventricular tachyarrhythmias. Some new generation ICDs have incorporated atrial Antitachycardia Pacing Therapy (ATP) and atrial Pacing algorithms designed specifically for the prevention of AF. In the GEM III AT clinical evaluation, atrial ATP efficacy for termination of AF and AT was assessed. Overall ATP efficacy for AF/AT, based on device classification, was 40% when adjusted using the Generalized Estimating Equations to account for correlated data that arises from utilizing multiple episodes in some patients. However, many episodes of AF/AT were noted to terminate within 10 minutes of onset. Applying a more conservative definition of efficacy, termination within 20 sec of delivery of the last atrial ATP, efficacy for termination of AF/AT was 26%. 50 Hz burst Pacing was shown to have minimal efficacy for termination of AF and modest incremental benefit following ramp or burst Pacing therapies for AT. These observations provide a more realistic expectation of the value of atrial ATP in the ICD population with AF. Atrial ATP terminates some episodes of AT but previously reported efficacy rates of 40–50% are exaggerated and in part reflect spontaneous terminations of some AF/AT episodes.