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INFLUENCE OF CYCLE LENGTH VARIATIONS ON ANTITACHYCADIA PACING EFFECTIVENESS AMONG ICD PATIENTS.
MedLine Citation:
PMID:  23085131     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Antitachycardia pacing (ATP) fails to terminate 5-25 % of ventricular tachycardias (VT) occurring in ICD patients. We speculated that small fluctuations in VT cycle length (CL) may be related to the efficacy of the subsequent ATP. OBJECTIVE: To determine the relationship between the R-R variations of the last 12 R-R intervals before ATP and the efficacy of the first ATP attempt. METHODS: We studied 551 VTs (CL: 329±35 ms) occurring in 67 patients. We also analyzed the percentage of variation (P-RR), which was calculated by dividing the mean difference between each R-R interval and the next one by the CL (x100), and the acceleration index (AI), which was calculated by dividing the CL of the first 6 R-R intervals by the CL of the next 6. RESULTS: The effectiveness of the first ATP therapy was 81%, being higher in VTs with AI<1 (85 vs. 64%; p<0.001). After classifying the events according to the tertiles of P-RR, ATP efficiency was better in higher values of P-RR (VTs with AI<1): 99% (third tertile) vs. 85% (second tertile) vs. 76% (first tertile), p<0.001; and for VTs with AI≥1: 94% vs. 68% vs. 42% (p<0.001). By logistic regression, the P-RR, % (OR=2.37; p<0.001), and an AI<1 (OR=4.17; p<0.001) were found to be independent predictors of successful first ATP attempts. CONCLUSIONS: Small changes in the CL increase the effectiveness of ATP significantly. VTs with lower degrees of R-R fluctuations, especially when the pattern is a progressive CL shortening, are infrequently terminated by ATP.
Authors:
Javier Jiménez-Candil; Jesús Hernández; Md Ana Martín; José Moríñigo; Rosana López; Claudio Ledesma; Cándido Martín-Luengo
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-17
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Arrhythmias Unit, Cardiology Department, IBSAL-University Hospital, Salamanca, Spain. Electronic address: jimenezcandil@secardiologia.es.
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