Anti-tachycardia Pacing for Termination of Rapid Ventricular Tachycardia in Patients with Implantable Cardioverter-Defibrillators. The PITAGORA ICD Trial

In patients with an implantable cardioverter–defibrillator (ICD) many episodes of rapid monomorphic ventricular tachycardia (VT) may be labelled ventricular fibrillation (VF) by the ICD and treated by painful shocks [1, 2]. Several observational studies have shown that ventricular antitachycardia pacing (ATP) is effective in VT termination [1–5]. The PainFREE Rx trial [6] has enrolled 220 patients with coronary artery disease and standard ICD indications, programmed a standardised ventricular detection and therapy algorithm (two burst sequences, eight pulses, 88%) for arrhythmias faster than 188 bpm (320 ms) and showed that: 43% of arrhythmias were detected in the traditional VF zone of < 320 ms 93% of arrhythmias detected in the VF zone were detected as fast VT (FVT) Empirical ATP therapy terminates 85% of FVT episodes with cycle length (CL) from 240 to 320 ms (250–190 bpm) at the first attempt The number of shocks saved by enabling ATP for FVT was 396 out of 446 detected episodes The low observed incidence of syncopes and FVT acceleration was no greater than that reported in other studies of ICD patients