Prospective multicenter randomized trial of fast ventricular tachycardia termination by prolonged versus conventional anti-tachyarrhythmia burst pacing in implantable cardioverter-defibrillator patients-Atp DeliVery for pAiNless ICD thErapy (ADVANCE-D) Trial results

Abstract

Purpose: The purpose of the trial was to quantify and compare the efficacy of two different sequences of burst anti-tachycardia pacing (ATP) strategies for the termination of fast ventricular tachycardia.

Methods: The trial was prospective, multicenter, parallel and randomized, enrolling patients with an indication for implantable cardioverter-defibrillator implantation.

Results: From February 2004, 925 patients were randomized and followed-up for 12 months. Eight pulses ATP terminated 64% of episodes vs. 70% in the 15-pulse group (p = 0.504). Fifteen pulses proved significantly better in patients without a previous history of heart failure (p = 0.014) and in patients with LVEF >or= 40% (p = 0.016). No significant differences between groups were observed with regard to syncope/near-syncope occurrence.

Conclusion: In the general population, 15-pulse ATP is as effective and safe as eight-pulse ATP. The efficacy of ATP on fast ventricular arrhythmias confirmed once more the striking importance of careful device programming in order to reduce painful shocks.

Fig. 1

Detection intervals and therapy programming description

Fig. 2

ERB adjudication of episodes detected by ICD as spontaneous ventricular tachyarrhythmia. Details on the treatments delivered for episodes appropriately and inappropriately detected in the FVT window are reported. Not treated episodes that did not received any treatment. ATP only episodes treated only by ATP. Shock episodes treated with at least one shock