The following is a summary of “EFFICACY OF BURST VS RAMP ANTITACHYCARDIA PACING AFTER FAILED BURST ANTITACHYCARDIA PACING,” published in the March 2023 issue of Cardiology by Hindi, et al.
Patients with cardiomyopathy at high risk of sudden cardiac death due to VT/VF are often treated with implantable cardioverter-defibrillators (ICDs) and anti-tachycardia pacing (ATP) to terminate monomorphic VT (MMVT). ATP can be delivered with a fixed coupling interval (BURST) or a progressively shorter coupling interval (RAMP). Still, it was determined whether BURST was superior to RAMP after initial failed attempts. For a study, researchers sought to evaluate the efficacy of BURST-BURST vs. BURST-RAMP and BURST-BURST-BURST vs. BURST-BURST-RAMP in patients with cardiomyopathy.
After enrollment in the Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure Trial (RAFT), the study included all patients with VT treated with ATP. The success, lack of effect, or acceleration of the second and third attempts of ATP (BURST vs. RAMP) for each episode of VT where BURST had failed were assessed. The study included 928 patients with EF ≤30% and a mean follow-up of 40 ± 20 months. There were 7,787 episodes of MMVT analyzed.
Of the 613 episodes that remained in MMVT after an initial BURST, 407 were treated with BURST-BURST and 206 with BURST-RAMP. BURST-BURST was more successful (50% vs. 40.3%, P<0.025) and less likely to accelerate (4.3% vs. 21.4%, P<0.001) than BURST-RAMP. Of the 178 episodes that remained in MMVT after a second failed BURST, 53 were treated with BURST-BURST-BURST and 125 with BURST-BURST-RAMP. BURST-BURST-RAMP was more successful (55.2% vs. 37.6%, P=0.033) than BURST-BURST-BURST with no difference in acceleration (4.8% vs. 2%, P=0.361).
BURST-BURST-RAMP is the most effective ATP strategy in patients with cardiomyopathy at high risk of sudden cardiac death.