• Ignasi Anguera, Paolo Dallaglio, Jose Martínez-Ferrer, Aníbal Rodríguez, Javier Alzueta, Julián Pérez-Villacastín, José Manuel Porres, Xavier Viñolas, Adolfo Fontenla, Ignacio Fernández-Lozano, Arcadio García-Alberola, and Xavier Sabaté.
• Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain.
• J. Cardiovasc. Electrophysiol. 2015 Jul 1; 26 (7): 774-82.

IntroductionAn empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst.Methods And ResultsWe analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness.ConclusionThis study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.© 2015 Wiley Periodicals, Inc.

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