The Role of ATP in Treating ICD Patients

Multiple clinical studies demonstrate that ATP plays a valuable role in treating ICD patients.2,3,4,6 This page reviews the clinical evidence behind the use of ATP in treating ICD patients. It discusses the efficacy, safety, utility, and impact on quality of life ATP can provide.

CAN MORE ATP
RESULT IN FEWER SHOCKS?

A new analysis from the international multicenter Shock-Less study (4,112 patients) found that more ATP attempts resulted in fewer shocked episodes.19 

 

  • VT/FVT episodes in ICD patients with multiple (>3) ATP sequences programmed were less likely to be treated by a shock than VT/FVT episodes in ICD patients with fewer (<3) ATP sequences programmed.19
  • The benefit of multiple ATP sequences was independent of whether the patient had a primary or secondary prevention ICD indication.19

A recent analysis of the Medtronic U.S. ICD CareLink database (>100,000 patients) suggests that only about half of ICD patients currently have three or more ATP sequences programmed.20 Programming multiple (>3) ATP sequences may provide an opportunity to reduce unnecessary shocks in more patients.20 

 


 

Listen to Medtronic Scientist Mark Brown discuss the results of his poster presentation Characteristics of Ventricular Tachyarrhythmias and Their Susceptibility to ATP Termination in Patients with Ischemic and Nonischemic Cardiomyopathy: A Meta-...


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Ventricular ATP: Basic Therapy Mechanisms and Optimal Programming Strategies to Reduce Shocks

In this educational video, Dr. Koneru, Dr. Cheng, and Dr. Brown discuss Ventricular Antitachycardia Pacing (ATP) and its role in reducing shocks, reducing healthcare utilization, and improving ICD patients’ quality of life. This education session covers the mechanisms of pacing-induced arrhythmia termination, current ATP clinical evidence, and optimal ATP programming strategies.

References

Arenal A, Proclemer A, Kloppe A, et al. Different impact of long-detection interval and anti-tachycardia pacing in reducing unnecessary shocks: data from the ADVANCE III trial. Europace. 2016; 18(11): 1719-1725. doi:10.1093/europace/euw032
Rickard J, Whellen D, Sherfesee L, et al. Characterization of health care utilization in patients receiving implantable cardioverter-defibrillator therapies: An analysis of the managed ventricular pacing trial. Heart Rhythm. 2017; 14(9):1382-1387.
3 Wathen M, DeGroot PJ, Sweeney MO, et al. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results Circulation. 2004; 110(17): 2591-2596. doi: 10.1161/01.CIR.0000145610.64014.E4
Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm. 2010; 7(3): 353-60. doi: 10.1016/j.hrthm.2009.11.027. 
Mastenbroek MH, Pedersen SS, van der Tweel I, Doevendans PA, Meine M. Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study). Am J Cardiol. 2016; 117(4): 596-604. doi: 10.1016/j.amjcard.2015.11.052
6 Fischer Al, Ousdigian KT, Johnson JW, Gillbert JM, Wilkoff BL. The impact of atrial fibrillation with rapid ventricular rates and device programming on shocks in 106,513 ICD and CRT-D patients. Heart Rhythm. 2012; 9(1): 24-31. doi: 10.1016/j.hrthm.2011.08.005. 
Landolina M, Lunati M, Boriani G, et al. Ventricular antitachycardia pacing therapy in patients with heart failure implanted with a cardiac resynchronization therapy defibrillator device: Efficacy, safety, and impact on mortality. Heart Rhythm. 2016; 13(2): 472-480. doi: 10.1016/j.hrthm.2015.10.022.
Sun S, Johnson J, DeGroot P, Brown ML, Obel O. Effect of ICD Therapies on Mortality in the OMNI Trial. J Cardiovasc Electrophysiol. 2016; 27(2): 192-199. doi: 10.1111/jce.12860.
Wathen MS, Volosin KJ, Sweeney MO, et al. Ventricular anti-tachycardia pacing by implantable cardioverter defibrillators reduces shocks for inappropriately detected supraventricular tachycardia [abstract]. Heart Rhythm. 2004; 1: S148. 
10 Sears S, Whited A, Koehler J, Gunderson B. Examination of the differential impacts of antitachycardia pacing vs. shock on patient activity in the EMPIRIC study. Europace. 2015; 17(3): 417-423. doi: 10.1093/europace/euu305 
11 Aurrichio Al, Schloss EJ, Kurita T, et al. Low inappropriate shock rates in patients with single- and dual/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results. Heart Rhythm. 2015; 12(5): 926–936 doi: 10.1016/j.hrthm.2015.01.017
12 Strickberger SA, Canby R, Cooper J, et al. Association of Antitachycardia Pacing or Shocks With Survival in 69,000 Patients With an Implantable Defibrillator. J Cardiovasc Electrophysiol. 2017; 28(4): 416-422. doi: 10.1111/jce.13170 
13  Moss AJ, Schuger C, Beck CA, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. December 13, 2012;367(24):2275-2283.
14 Wilkoff BL, Williamson BD, Stern RS, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol. August 12, 2008;52(7):541-550.
15 Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 2016;30(6):473-83.
16 Cheng A, Joung B, Brown M, et al. Characteristics Of Ventricular Tachyarrhythmias AND Their Susceptibility To ATP Termination In Patients With Ischemic And Nonischemic Cardiomyopathy: A Meta-analysis Of 3 Large Clinical Trials. Heart Rhythm 2018 15:5 Supplement 1 (S178-S283). Presented at HRS 2018. Poster B-PO02-148. Poster Session II, May 10, 2018. 
17 Silver MT, Sterns LD, Piccini JP et al. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks. Heart Rhythm. 2015;12:545-553.
18 Auricchio A, Schloss EJ, Kurita T, et al. Low inappropriate shock rates in patients with single and dual/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results; Heart Rhythm. 2015; 12;926-936.
19 Joung B, Lexcen D, Ching C, et al. Antitachycardia Pacing (ATP) programing strategies further unnecessary Implantable Cardioverter Defibrillator (ICD) Shocks. Presented at APHRS October 2018 Taipei, Taiwan.
20 Chinmai Parikh, ATP programming in US ICD CareLink patients Medtronic Data on File. January 2019.

Last updated: 
02 Apr 2019