| Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. | |
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MedLine Citation:
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PMID: 15492306 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Successful antitachycardia pacing (ATP) terminates ventricular tachycardia (VT) up to 250 bpm without the need for painful shocks in implantable cardioverter-defibrillator (ICD) patients. Fast VT (FVT) >200 bpm is often treated by shock because of safety concerns, however. This prospective, randomized, multicenter trial compares the safety and utility of empirical ATP with shocks for FVT in a broad ICD population. METHODS AND RESULTS: We randomized 634 ICD patients to 2 arms-standardized empirical ATP (n=313) or shock (n=321)-for initial therapy of spontaneous FVT. ICDs were programmed to detect FVT when 18 of 24 intervals were 188 to 250 bpm and 0 of the last 8 intervals were >250 bpm. Initial FVT therapy was ATP (8 pulses, 88% of FVT cycle length) or shock at 10 J above the defibrillation threshold. Syncope and arrhythmic symptoms were collected through patient diaries and interviews. In 11+/-3 months of follow-up, 431 episodes of FVT occurred in 98 patients, representing 32% of ventricular tachyarrhythmias and 76% of those that would be detected as ventricular fibrillation and shocked with traditional ICD programming. ATP was effective in 229 of 284 episodes in the ATP arm (81%, 72% adjusted). Acceleration, episode duration, syncope, and sudden death were similar between arms. Quality of life, measured with the SF-36, improved in patients with FVT in both arms but more so in the ATP arm. CONCLUSIONS: Compared with shocks, empirical ATP for FVT is highly effective, is equally safe, and improves quality of life. ATP may be the preferred FVT therapy in most ICD patients. |
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Authors:
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Mark S Wathen; Paul J DeGroot; Michael O Sweeney; Alice J Stark; Mary F Otterness; Wayne O Adkisson; Robert C Canby; Koroush Khalighi; Christian Machado; Donald S Rubenstein; Kent J Volosin; |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2004-10-18 |
Journal Detail:
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Title: Circulation Volume: 110 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2004 Oct |
Date Detail:
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Created Date: 2004-10-26 Completed Date: 2005-05-12 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2591-6 Citation Subset: AIM; IM |
Affiliation:
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Vanderbilt Page-Campbell Heart Institute, Vanderbilt University Medical Center, 2220 Pierce, Nashville, TN 37232, USA. mark.wathen@vanderbilt.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Pacing, Artificial* / adverse effects Defibrillators, Implantable* / adverse effects Female Humans Kinetics Male Quality of Life Tachycardia, Ventricular / diagnosis, therapy* |
| Comments/Corrections | |
Comment In:
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Evid Based Cardiovasc Med. 2005 Mar;9(1):86-8
[PMID:
16379997
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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