on February 13, 2009
Published online before print February 13, 2009, doi: 10.1161/CIRCEP.108.804211
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Original Article |
A randomized study to compare Ramp vs Burst antitachycardia pacing therapies to treat fast ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators: the PITAGORA ICD trial.
1 Garibaldi-Nesima Hospital Catania;
2 Civico e Benfratelli Hospital, Palermo;
3 Rummo Hospital, Benevento;
4 S. Antonio Abate Hospital, Trapani;
5 Umberto I Hospital, Enna;
6 Perrino Hospital, Brindisi;
7 S. Sebastiano Hospital, Caserta;
8 Villa Sofia Hospital, Palermo;
9 S. Elia Hospital, Caltanisetta;
10 Moscatello Hospital, Augusta;
11 S. Giovanni di Dio Hospital, Agrigento;
12 Garibaldi Hospital, Catania;
13 Medtronic Italy
14 E-mail: andrea.grammatico{at}medtronic.com
Background—In patients with implantable cardioverter-defibrillators (ICD), anti-tachycardia pacing (ATP) is highly effective in terminating fast ventricular tachycardias (FVT) and lowers the use of high-energy shocks, without increasing the risk of arrhythmia acceleration or syncope.
Methods and Results—Aim of the PITAGORA ICD trial was to randomly compare two ATP strategies (88% coupling interval Burst vs 91% coupling interval Ramp, both 8 pulses) in terms of ATP efficacy, arrhythmia acceleration and syncope. Two-hundred and six ICD patients (83% male, 67±11 years) were enrolled. FVT episodes with cycle lengths between 240 ms and 320 ms were treated by 1 ATP sequence and, in the event of failure, by shocks. Over a median follow-up of 36 months, 829 spontaneous ventricular tachyarrhythmia episodes were detected in 79 patients. Episode review identified 595 episodes as true ventricular arrhythmias in 72 patients; devices classified 111 (18.7%) episodes as VF, 216 (36.3%) as FVT, and 268 (45.0%) as VT. Fifty-six patients had 214 treated FVT episodes- 2 FVT self-terminated before ATP release; 44 (79%) of these had at least 1 effective ATP intervention and 34 (61%) were spared ICD shocks. Burst terminated 100/133 (75.2%) FVT episodes, while Ramp terminated 44/81 (54.3%) (P=0.015). Acceleration occurred in 9/214 (4.2%) FVT episodes treated: 6 episodes in 3 Ramp patients and 3 episodes in 3 Burst patients. Two patients—one in each group—suffered one syncopal event associated to a non-terminated FVT episode.
Conclusions—Burst is significantly more efficacious than Ramp in terminating FVT episodes. As the first therapy for FVT episodes, ATP carries a low risk of acceleration or syncopal events.
Key Words: reentry • shock • tachycardia • Burst, • implantable cardioverter defibrillator
Author contributions: Submitted on behalf of PITAGORA ICD Study Investigators
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