The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators
Introduction The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. Methods and results From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes...
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Published in | Journal of interventional cardiac electrophysiology Vol. 62; no. 1; pp. 103 - 111 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.10.2021
Springer Nature B.V |
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Abstract | Introduction
The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate.
Methods and results
From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT (
n
= 93) had longer duration (23.7 min, CI95%: 10–39), compared with episodes treated effectively by anti-tachycardia pacing (ATP;
n
= 527; 0.32 min, IC95%: 0.22–0, 48) or shock (
n
= 39; 1 min, CI95%: 0.8–1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45–55] vs. 41 days [CI95%: 39–44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6–15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank
p
= 0.28). In a Cox regression analysis, the variable “presenting untreated episodes of slow VT” was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31,
p
= 0.009), narrower QRS (OR: 1.036,
p
= 0.037) and diabetes (OR 4.673,
p
= 0.049) appropriately predict survival.
Conclusions
Untreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality. |
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AbstractList | The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate.
From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT (n = 93) had longer duration (23.7 min, CI95%: 10-39), compared with episodes treated effectively by anti-tachycardia pacing (ATP; n = 527; 0.32 min, IC95%: 0.22-0, 48) or shock (n = 39; 1 min, CI95%: 0.8-1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45-55] vs. 41 days [CI95%: 39-44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6-15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank p = 0.28). In a Cox regression analysis, the variable "presenting untreated episodes of slow VT" was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31, p = 0.009), narrower QRS (OR: 1.036, p = 0.037) and diabetes (OR 4.673, p = 0.049) appropriately predict survival.
Untreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality. Introduction The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. Methods and results From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT ( n = 93) had longer duration (23.7 min, CI95%: 10–39), compared with episodes treated effectively by anti-tachycardia pacing (ATP; n = 527; 0.32 min, IC95%: 0.22–0, 48) or shock ( n = 39; 1 min, CI95%: 0.8–1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45–55] vs. 41 days [CI95%: 39–44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6–15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank p = 0.28). In a Cox regression analysis, the variable “presenting untreated episodes of slow VT” was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31, p = 0.009), narrower QRS (OR: 1.036, p = 0.037) and diabetes (OR 4.673, p = 0.049) appropriately predict survival. Conclusions Untreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality. INTRODUCTIONThe clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. METHODS AND RESULTSFrom the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT (n = 93) had longer duration (23.7 min, CI95%: 10-39), compared with episodes treated effectively by anti-tachycardia pacing (ATP; n = 527; 0.32 min, IC95%: 0.22-0, 48) or shock (n = 39; 1 min, CI95%: 0.8-1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45-55] vs. 41 days [CI95%: 39-44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6-15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank p = 0.28). In a Cox regression analysis, the variable "presenting untreated episodes of slow VT" was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31, p = 0.009), narrower QRS (OR: 1.036, p = 0.037) and diabetes (OR 4.673, p = 0.049) appropriately predict survival. CONCLUSIONSUntreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality. |
Author | Picazo, Marta Calvo, David Rodríguez, Aníbal Morís, César Viñolas, Xabier Pérez, Diego Rubín, José Basterra, Nuria García-Iglesias, Daniel Martínez-Ferrer, José Bautista Alzueta, Javier |
Author_xml | – sequence: 1 givenname: David orcidid: 0000-0002-8689-4011 surname: Calvo fullname: Calvo, David email: dcalvo307@secardiologia.es organization: Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias – sequence: 2 givenname: Marta surname: Picazo fullname: Picazo, Marta organization: Medtronic Ibérica – sequence: 3 givenname: Daniel surname: García-Iglesias fullname: García-Iglesias, Daniel organization: Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias – sequence: 4 givenname: Diego surname: Pérez fullname: Pérez, Diego organization: Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias – sequence: 5 givenname: José surname: Rubín fullname: Rubín, José organization: Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias – sequence: 6 givenname: José Bautista surname: Martínez-Ferrer fullname: Martínez-Ferrer, José Bautista organization: Hospital Universitario de Araba – sequence: 7 givenname: Aníbal surname: Rodríguez fullname: Rodríguez, Aníbal organization: Hospital Universitario de Canarias – sequence: 8 givenname: Xabier surname: Viñolas fullname: Viñolas, Xabier organization: Hospital de Santa Creu i San Pau – sequence: 9 givenname: Javier surname: Alzueta fullname: Alzueta, Javier organization: Hospital Clínico Universitario Virgen de la Victoria – sequence: 10 givenname: Nuria surname: Basterra fullname: Basterra, Nuria organization: Hospital de Navarra – sequence: 11 givenname: César surname: Morís fullname: Morís, César organization: Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias |
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Cites_doi | 10.1016/0735-1097(96)00123-4 10.1111/jce.12699 10.1161/CIRCULATIONAHA.105.533513 10.1056/NEJMoa071098 10.1161/CIRCEP.114.001623 10.1056/NEJMoa1211107 10.1161/01.CIR.0000140259.16185.7D 10.1007/s00380-016-0850-x 10.1016/j.jspi.2011.09.003 10.1016/j.cjca.2014.11.023 10.1001/jama.2013.4598 10.1016/j.hlc.2012.07.017 10.1161/01.CIR.67.2.316 10.1016/j.jacc.2006.03.037 10.1161/CIRCULATIONAHA.110.976092 10.1093/europace/euv393 10.1161/CIRCULATIONAHA.114.009468 10.1016/S0735-1097(00)00733-6 10.1007/978-1-4899-4541-9 10.1016/j.hrthm.2009.11.027 10.1136/heartjnl-2012-301853 10.1093/europace/euz065 10.1161/01.CIR.91.8.2204 |
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Keywords | Slow ventricular tachycardia ICD therapy Clinical outcomes |
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Snippet | Introduction
The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under... The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. From... IntroductionThe clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under... INTRODUCTIONThe clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under... |
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SubjectTerms | Accelerated Idioventricular Rhythm ATP Atrial Fibrillation Cardiac arrhythmia Cardiology Defibrillators Defibrillators, Implantable Diabetes mellitus Fibrillation Heart Humans Medical prognosis Medicine Medicine & Public Health Morbidity Mortality Patients Prospective Studies Regression analysis Tachycardia Tachycardia, Ventricular - therapy Ventricle |
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Title | The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators |
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