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Arrhythmic episodes in patients implanted with a cardioverter-defibrillator - results from the Prospective Study on Predictive Quality with Preferencing PainFree ATP therapies (4P)

François Regoli, Denis Graf, Beat Schaer, Firat Duru, Peter Ammann, Lorenza Mangoni Di S Stefano, Barbara Naegli, Haran Burri, Rainer Zbinden, Nazmi Krasniqi, Martin Fromer & 4P Study Group

abstract

BACKGROUND
Little is known about the ICD performance using enhanced detection algorithms in unselected, non-trial patients. Performance of recent generation ICD equipped with SmartShock™ technology (SST) for detection and conversion of ventricular tachyarrhythmias (VTA) was investigated.

METHODS
4P was a prospective, multicenter, observational study conducted in 10 Swiss implanting centers. Patients with a Class I indication according to international guidelines were included and received an ICD with SST. ICD discrimination capability was assessed by evaluating SST performance; therapy efficacy was assessed by rate of VTA conversions by ATP and by rescue shocks.

RESULTS
Overall, 196 patients were included in the analysis with a mean duration of follow-up of 27.7 months (452 patient-years of observation). Patient-specific rather than recommended programming was preferred. Device-detected episodes were frequent (5147 episodes in 146 patients, 74.5%). In 44 patients (22.4%), 1274 episodes were categorized as VTA; only 215 episodes were symptomatic. ATP was the first-line therapy and highly effective (99.9% success rate at the episode level, 100.0% at the patient level). Rescue shocks were rare (66 episodes in 28 patients); 7 shocks in 5 patients (2.6%) were inappropriate. Death and hospitalization rates were low.

CONCLUSIONS
In a cohort of non-trial, unselected ICD patients, VTA episodes were frequent. The 4P results confirm the robustness of VTA detection by SST and the effectiveness of ATP treatment, hence limiting overall ICD shock burden.
   
citation Regoli F, Graf D, Schaer B, Duru F, Ammann P, Stefano L M d S, Naegli B, Burri H, Zbinden R, Krasniqi N, Fromer M, 4P Study Group . Arrhythmic episodes in patients implanted with a cardioverter-defibrillator - results from the Prospective Study on Predictive Quality with Preferencing PainFree ATP therapies (4P). BMC Cardiovasc Disord 2019; 19:146.
   
type journal paper/review (English)
date of publishing 17-06-2019
journal title BMC Cardiovasc Disord (19/1)
ISSN electronic 1471-2261
pages 146
PubMed 31208342
DOI 10.1186/s12872-019-1121-4