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Prevention of Sustained Ventricular Tachyarrhythmias in Patients with Implantable Cardioverter-Defibrillators—The PREVENT Study

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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.

Results: 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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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Emergency Hospital, Berlin, Germany

    Dietmar Wietholt, Volker Kuehlkamp, Ekkhard Meisel, Ellen Hoffmann, Christoph Stellbrink, Joerg Neuzner, Karl Seidl, Peter Szigat & Juergen Potratz

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  1. Dietmar Wietholt
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  2. Volker Kuehlkamp
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Correspondence to Dietmar Wietholt.

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Wietholt, D., Kuehlkamp, V., Meisel, E. et al. Prevention of Sustained Ventricular Tachyarrhythmias in Patients with Implantable Cardioverter-Defibrillators—The PREVENT Study. J Interv Card Electrophysiol 9, 383–389 (2003). https://doi.org/10.1023/A:1027407829958

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