The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators
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The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators David Calvo 1 & Marta Picazo 2 & Daniel García-Iglesias 1 & Diego Pérez 1 & José Rubín 1 & José Bautista Martínez-Ferrer 3 & Aníbal Rodríguez 4 & Xabier Viñolas 5 & Javier Alzueta 6 & Nuria Basterra 7 & César Morís 1 Received: 1 June 2020 / Accepted: 14 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Slow ventricular tachycardia . ICD therapy . Clinical outcomes Key questions What is already known about this subject? Ventricular tachycardia (VT) occurring below the programmed threshold for arrhythmia detection is frequently observed and their clinical significance is still under debate. What does this study add? Patients with slow ventricular tachycardia (VT; cycle length 500–320 ms) untreated by the ICDs do not display a worsen prognosis compared with patients with slow VT tachycardia treated by the ICD. Treatment of slow VT by high voltage shock delivered from the ICD does not decrease morbidity or mortality. How might this impact on clinical practice? Our results support the limitation of therapies to ATP only in patients with slow VT, thus avoiding shock therapies that have been associated with increased risk of morbidity and mortality. * David Calvo dcalvo307@se
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