BIVentricular versus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: The ADVANCE CRT-D Trial - 05/08/11
, Frédéric Anselme, MD b, Jacques Clementy, MD c, Massimo Santini, MD d, José Martínez-Ferrer, MD e, Tiziana De Santo, MS f, Elisabetta Santi, MS f, Jeorg O. Schwab, MD gon behalf of the ADVANCE CRT-D Investigatorsh
Résumé |
Background |
This multicenter, prospective, randomized, controlled, parallel trial compares the efficacy of biventricular (BIV) versus right ventricular (RV) antitachycardia pacing (ATP) in terminating all kinds of ventricular tachycardia (VT).
Methods |
Five hundred twenty-six patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D) device were enrolled and randomized 1:1 to either BIV (266) or RV (260) ATP (single burst 8 pulse, 88% coupling interval) and were followed up for 12 months.
Results |
During 12 months' follow-up, 1,077 ventricular episodes in 180 patients were detected and classified: 634 true VTs divided into 69 ventricular fibrillation (VF) (11%), 202 fast ventricular tachycardia (FVT) (32%), and 363 VT (57%). A comparable first ATP efficacy (BIV 65% vs RV 68%, P = .59) was observed in FVT + VT, in VT zone (BIV 62% vs RV 71%, P = .25), and in FVT zone (BIV 71% vs RV 61%, P = .34). A trend toward lower accelerations during ATP applied to FVT was observed in the BIV group (3.5% BIV vs 10.2% RV, P = .163). No syncope/presyncope occurred during ATP for FVT in the BIV group versus 4 events (3.2%) in the RV group (P = .016). biventricular ATP was more effective in treating FVT in coronary artery disease (CAD) patients (P = .032), whereas both modalities presented similar efficacy in patients with non-CAD etiology (P = .549).
Conclusions |
Antitachycardia pacing is effective in patients implanted with a CRT-D device. No significant differences in efficacy emerged between BIV- and RV-delivered ATP in the general population, whereas BIV ATP seems to present a safer profile in ischemic patients.
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| RCT#: NCT00147290. |
Vol 159 - N° 6
P. 1116 - juin 2010 Retour au numéro
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