Document Detail


The 1+1 trial: a prospective trial of a dual- versus a single-chamber implantable defibrillator in patients with slow ventricular tachycardias.
MedLine Citation:
PMID:  15326069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The tachycardia detection interval (TDI) in implantable cardioverter/defibrillators (ICDs) is conventionally programmed according to the slowest documented ventricular tachycardia (VT), with a safety margin of 30 to 60 ms. With this margin, VTs above the TDI may occur. However, longer TDIs are associated with an increased risk of inappropriate therapy. We hypothesized that patients with slow VTs (<200 bpm) may benefit from a long TDI and a dual-chamber detection algorithm compared with a conventionally programmed single-chamber ICD. METHODS AND RESULTS: Patients with VTs <200 bpm were implanted with a dual-chamber ICD that was randomly programmed to a dual-chamber algorithm and a TDI of > or =469 ms or to a single-chamber algorithm with a TDI 30 to 60 ms above the slowest documented VT cycle length and the enhancement criteria of cycle length variation and acceleration. The primary combined end point was the number of all inappropriate therapies, VTs above the TDI, and VTs with significant therapy delay (>2 minutes). After 6 months, a crossover analysis was performed. Total follow-up was 1 year. One hundred two patients were included in the study. The programmed TDI was 500+/-36 ms during the dual-chamber phase and 424+/-63 ms during the single-chamber phase. For the primary end point (inappropriate therapies, VTs above the TDI, or VTs with detection delay), a moderate superiority of the dual-chamber mode was found: Mann-Whitney estimator=0.6661; 95% CI, 0.5565 to 0.7758; P=0.0040. CONCLUSIONS: Dual-chamber detection with a longer TDI improves VT detection and does not increase the rate of inappropriate therapies despite a considerable increase in tachycardia burden.
Authors:
Dietmar Bänsch; Frank Steffgen; Gerian Grönefeld; Christian Wolpert; Dirk Böcker; Ralph-Uwe Mletzko; Wolfgang Schöls; Karlheinz Seidl; Michael Piel; Feifan Ouyang; Stefan H Hohnloser; Karl-Heinz Kuck
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2004-08-23
Journal Detail:
Title:  Circulation     Volume:  110     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-09-01     Completed Date:  2005-03-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1022-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, St Georg Hospital, Hamburg, Germany. BAE151162@AOL.com
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Anti-Arrhythmia Agents / therapeutic use
Area Under Curve
Combined Modality Therapy
Cross-Over Studies
Defibrillators, Implantable* / adverse effects
Electric Countershock / methods*
Endpoint Determination
Equipment Failure
Follow-Up Studies
Heart Rate
Humans
Life Tables
Prospective Studies
ROC Curve
Sensitivity and Specificity
Single-Blind Method
Tachycardia, Ventricular / diagnosis,  drug therapy,  physiopathology,  therapy*
Unnecessary Procedures
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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