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World J Cardiol. May 26, 2017; 9(5): 429-436
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.429
Antitachycardia pacing programming in implantable cardioverter defibrillator: A systematic review
Elia De Maria, Daniele Giacopelli, Ambra Borghi, Letizia Modonesi, Stefano Cappelli
Elia De Maria, Ambra Borghi, Letizia Modonesi, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy
Daniele Giacopelli, Biotronik Italia, Dipartimento Clinico, 20090 Vimodrone, Italy
Author contributions: De Maria E and Giacopelli D contributed to concept/design, data analysis/interpretation, drafting the article, critical revision, approval; Borghi A, Modonesi L and Cappelli S contributed to drafting the article, critical revision, approval.
Conflict-of-interest statement: Daniele Giacopelli is a Biotronik employee. The other authors report no relationships that could be construed as a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elia De Maria, MD, PhD, Chief of Arrhythmology Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012 Carpi (Modena), Italy. e.demaria@inwind.it
Telephone: +39-05-9659320 Fax: +39-05-9659387
Received: November 14, 2016
Peer-review started: November 14, 2016
First decision: February 15, 2017
Revised: February 24, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 26, 2017
Abstract

Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient’s quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias (188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation (VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.

Keywords: Implantable cardioverter defibrillator programming, Antitachycardia pacing, Ventricular tachycardia, Electrical antitachycardia therapy

Core tip: Antitachycardia pacing (ATP) has a great importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary shocks and it improves both patient’s quality of life and device longevity. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: Extended detection in ventricular fibrillation (VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate therapies and improves the survival of patients during medium term follow-up.