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Anti-tachycardia pacing (ATP) is a common initial treatment in the termination of ventricular arrhythmias in implantable cardioverter defibrillators (ICDs). We sought to assess the efficacy of burst and ramp ATP on ventricular arrhythmias at different tachycardia cycle lengths (TCL) in the RAFT trial.
Methods
The RAFT trial randomized patients with functional class II and III heart failure to ICDs ± cardiac resynchronization and had standardized programming; VT was treated with burst pacing (8 beats/ 88% TCL/ fixed rate), followed by ramp pacing (6 beats/88% TCL/10ms decrements) if burst pacing failed. All arrhythmia events were adjudicated.
Results
ATP was delivered a total of 7233 times (5583 burst and 1684 ramp) in 5779 episodes of VT, (TCL= 349 ± 51ms), among 740 patients with monomorphic VT. Overall, ATP was successful in terminating 62.2% (Burst 68.4%; Ramp 40.5% of VT episodes. VT with a rate of >200bpm, 150-200bpm, and 200bpm = 35.2%; 150-200bpm = 3.5%, <150bpm = 2.0%).
In the cohort of RAFT patients it appears that ATP therapy was most successful in treating VT between 150-200bpm. VT faster than 200bpm was more likely to accelerate after ATP therapy, however, they too were more likely to receive Ramp ATP.
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