CLINICAL STUDIES
Ventricular tachycardias above the initially programmed tachycardia detection interval in patients with implantable cardioverter-defibrillators
Incidence, prediction and significance
Dietmar Bänsch, MD ,
Marco Castrucci, MD*,
Dirk Böcker, MD*,
G.ünter Breithardt, MD, FACC, FESC* and
Michael Block, MD
* Department of Cardiology/Angiology and Institute for Research in Arteriosclerosis, Westfälische Wilhelms-University, Münster, Germany
Department of Cardiology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
Department of Cardiology, Krankenhaus Augustinum, München, Germany
Manuscript received May 4, 1999;
revised manuscript received January 20, 2000,
accepted March 29, 2000.
Reprint requests and correspondence: Dr. Dietmar Bänsch, Department of Internal Medicine II, Cardiology, Allgemeines Krankenhaus St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany
Bae151162{at}aol.com
OBJECTIVES
This retrospective study was performed to provide data on ventricular tachycardias (VT) with a cycle length longer than the initially programmed tachycardia detection interval (TDI) in patients with implantable cardioverter defibrillators (ICDs).
BACKGROUND
It has been clinical practice to program a safety margin of 30 to 60 ms between the slowest spontaneous or inducible VT and the TDI.
METHODS
Baseline characteristics of 659 consecutive patients with ICDs were prospectively; follow-up information was retrospectively collected.
RESULTS
During a mean follow-up of 31 ± 23 months, 377 patients (57.2%) had at least one recurrent VT or ventricular fibrillation; 47 patients (7.1%) suffered 61 VTs above the TDI. The risk of a VT above the TDI ranged between 2.7% and 3.5% per year during the first four years after ICD implantation. The difference between the cycle length of the slowest VT before ICD implantation, spontaneous or induced, and the first VT above TDI was 108 ± 58 ms. Fifty-four VTs (88.5%) above the TDI were associated with significant clinical symptoms (angina or palpitation 63.9%, heart failure 6.6% and syncope 8.2%). Six patients (9.8%) had to be resuscitated. Kaplan-Meyer analysis identified New York Heart Association class II or III (p = 0.021), ejection fraction < 0.40 (p = 0.027), spontaneous (p < 0.001) or inducible (p < 0.001) monomorphic VTs and the use of class III antiarrhythmic drugs (amiodarone, p < 0.001; sotalol, p = 0.004) as risk predictors of VTs above the TDI. The risk of recurrent VTs above TDI was 11.8%, 12.5% and 26.6% during the first, second and third year after first VT above TDI, respectively.
CONCLUSIONS
The risk of VTs above the TDI is significantly increased in some patients, and many VTs above TDI cause significant clinical symptoms. A larger safety margin between spontaneous or inducible VTs and the TDI seems to be necessary in selected patients. This is in conflict with an increased risk of inadequate episodes and demands highly specific and sensitive detection algorithms in these patients.
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Abbreviations and Acronyms
| | CL | = cycle length | | ECG | = electrocardiogram | | EF | = ejection fraction | | ICD | = implantable cardioverter defibrillator | | NYHA | = New York Heart Association | | PVS | = programmed ventricular stimulation | | TDI | = tachycardia detection interval | | VF | = ventricular fibrillation | | VT | = ventricular tachycardia |
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