Wietholt D, Kuehlkamp V, Meisel E, Hoffmann E, Stellbrink C, Neuzner J, Seidl K, Szigat P, Potratz J. Prevention of sustained ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators-the PREVENT study.
J Interv Card Electrophysiol 2003;
9:383-9. [PMID:
14618061 DOI:
10.1023/a:1027407829958]
[Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND
In patients with implantable cardioverter-defibrillators (ICDs), 25 to 45% of tachyarrhythmia episodes were initiated by short-long-short RR intervals.
METHODS
The prospective multi-center PREVENT study randomized patients implanted with ICDs capable of atrioventricular pacing, in order to compare-using a cross-over design with two 3-month treatment periods-the benefits of 'rate smoothing' (RS) as a 'pause-prevention algorithm' for the prevention of ventricular tachyarrhythmias.
RESULT
Follow-up included 219 patients with implanted ICDs, of whom 153 were eligible for analysis as per protocol. Fifty-seven of these patients (38%) had documented episodes of ventricular tachyarrhythmias during the six months follow-up. The total number of sustained ventricular tachyarrhythmia episodes was reduced from 358 with RS Off to 145 with RS On. RS was effective in reducing the number of short-long-short induced sustained ventricular episodes from 100 with RS Off to 40 with RS On. The Wilcoxon-Mann-Whitney point estimator equals 0.66 with a 95% confidence interval from 0.51 to 0.82 (relevant superiority; corresponding p = 0.039). There were no proarrhythmic effects due to rate smoothing within the scope of this study.
CONCLUSIONS
'Rate smoothing' significantly reduced sustained ventricular tachyarrhythmias in ICD patients. There is a relevant superiority of the treatment during the early six months of follow-up.
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