PO-05-078 SHOCK REDUCTION THROUGH EARLY DELIVERY OF ANTITACHYCARDIA PACING FOR FAST VENTRICULAR TACHYCARDIAS

Abstract

Antitachycardia pacing (ATP) is a programmable therapy in implantable cardiac defibrillator (ICD) devices that has been demonstrated to effectively reduce the need for shocks. Limited data, however, exists on the potential benefits of early ATP delivery in the ventricular fibrillation (VF) zone. While ATP is programmed to be delivered as a first line of therapy for ventricular tachycardia (VT) events, it does so only once the episode meets detection criteria by the ICD. Newer generations of BIOTRONIK ICDs have the ability for earlier delivery of ATP, called Early ATP OneShot, to be programmed in the VF therapy zone. Early ATP is delivered when 12 out of 16 events, plus stability criteria, are met to target fast VTs detected in the programmed VF therapy zone. This option is available for patients with longer detection times (VF detection counters of 16 out of 20 or higher) and allows the device to deliver ATP before episode detection counter criteria is met, thus providing therapy earlier than traditional ATP. To compare the success rates of Early ATP OneShot (eATP) for episodes in the VF zone against traditional ATP OneShot (tATP) programming. Using BIOTRONIK’s real-world research database, CERTITUDE, 696 patients with eATP capable ICD devices with VF episodes transmitted via remote monitoring were divided into groups based on tATP (n=584) or eATP (n=112) programming for the VF therapy zone. Each device detected episode was evaluated to determine the therapy (ATP and/or shocks) delivered, whether therapy was successful, or if the episode self-terminated. Patients with detection zone counters lower than 16 out of 20 were excluded. eATP was successful in 69.4% of cases in terminating episodes in the VF zone whereas tATP was successful in 49.1% of cases (p<0.0001). Extrapolation of the eATP success rate to the tATP cohort results in 30.0% less shocks (203 avoided shocks out of 676 total shocks). Cohorts did not differ statistically in mean R-R interval at episode detection, nor in device programming for detection limit zone or counters. Episode duration was shorter in the eATP cohort (p<0.0001). As compared to traditional programming, use of Early ATP OneShot provides increased success rates to terminate fast VTs detected in the VF zone, potentially reducing unnecessary shocks.Tabled 1Table: Comparison of ATP Therapy Groups for Device Detected VF Episodes (PO-05-078)OutcomeEarly ATP OneShotTraditional ATP OneShotp value (difference)Patients with VF Event112584-ATP Therapy Success Rate (Successes/Attempts)69.4% (161/232)49.1% (491/1001)<0.0001Median VF Episode Duration (sec)1217<0.0001Mean R-R interval at VF Episode Detection (ms)2572530.17Mean Programmed Rate of VF Detection Limit (ms)2882910.20Median Programmed Detection Counters for Programmed VF Zone (X/Y criteria)18/2418/240.94 Open table in a new tab