Patient‐by‐patient basis anti‐tachycardia pacing for fast ventricular tachycardia with structural heart diseases

Abstract

Background Anti‐tachycardia pacing (ATP) delivered from an implantable device is an important tool to terminate ventricular tachycardia (VT). But its real‐world efficacy for fast VT has not been fully studied. Methods Using the database of Nippon‐storm study, effect of patient‐by‐patient basis ATP programming for fast VT (≥ 188 bpm) was assessed for the patients with structural heart diseases. Fast VTs were divided into three groups depending on HR; Group‐A was 188–209 bpm, and Group‐B and Group‐C were 210–239 bpm and ≥ 240 bpm, respectively. Results During a median follow‐up of 28 months, 202 fast VT episodes (209±19 bpm) were demonstrated in the 85 patients. ATP terminated 151 of the 202 episodes (74.8%) in total. The success rate of the ATP was not different among the three groups; 73.3% in Group‐A, 80.6% in Group‐B and 66.7% in Group‐C. ATP success rate of more than 50% and more than 70% was 77.6% and 64.7% of the patients, respectively. LVEF was significantly higher in the patients with rather than without successful ATP therapy, and ROC analysis revealed that LVEF of 23% was the optimal cut‐off value. ATP was less effective in patients taking amiodarone, but etiology of the structural heart diseases, indication of the device implantation and all ECG parameters were not useful predictors for successful ATP therapy. Conclusions ATP highly terminated fast VT with wide HR‐ranges in patients with structural heart diseases, and should be considered as the first line therapy for fast VT except for patients with very low LVEF. This article is protected by copyright. All rights reserved