Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Clinical Trials D-MP07 - The A Through Z for CIEDs (ID 55) Moderated ePoster

D-MP07-01 - Programming Progressive Therapies For Ventricular Tachycardia: The Efficacy And Safety Of Additional Bursts, Ramps And Low-amplitude Shock (ID 840)


Background: The HRS/EHRA/APHRS/LAHRS expert consensus statement on optimal implantable cardioverter-defibrillator (ICD) programming recommends burst therapy followed by maximal-amplitude shocks for treatment of ventricular tachycardia (VT). Because evidence is scarce, the amount of bursts are not specified and the treatment by ramps and low-amplitude shocks are not recommended.
Objective: We retrospectively evaluated progressive therapies for VTs, estimating the chance of VT termination or acceleration of 3 bursts followed by 3 bursts or 3 ramps, followed by low-amplitude shocks (<15J) or maximal-amplitude shocks.
Methods: Using remote monitoring we screened patients from the University Hospital of Bordeaux (France) with Medtronic, Abbott, Biotronik, Boston Scientific or MicroPort ICDs for treated VT episodes >150 bpm.
Results: We analyzed 1182 episodes with confirmed VT and ≥1 ATP. Chance of termination was 64% after 1 burst (65% for VT 150-200 bpm, 61% for VT >200 bpm, P=0.4), 73% after 2 bursts and 78% after 3 bursts. Additional 3 ramps increased success to 88%, similar to adding 3 bursts (88%, P=NS). Acceleration occurred in 2.7% during the first 3 bursts, 4,2% during the second 3 bursts and 5.4% during the 3 ramps (P=0.12 compared to bursts). As a first shock, 41 low-amplitude shocks were 68% successful with acceleration in 12% and 176 maximal-amplitude shocks were 88% successful with 0 accelerations.
Conclusion: Programming additional burst therapies can avoid shocks in a substantial amount of cases. Ramps and low-amplitude shocks are not more efficient than bursts and maximal-output shocks but are associated with acceleration into life-threatening polymorphic tachycardia