Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCz5T6J9prWhGQWqcwBsJzzznS0066-782X201800050049510.5935/abc.20180078Letter to the EditorPrognostic Significance of Non-Sustained Ventricular Tachycardia Depends on Its Rate and DurationBozyelSerdar1University of Health and SciencesDerince Training and Research HospitalDepartment of CardiologyKocaeliTurkeyUniversity of Health and Sciences, Derince Training and Research Hospital, Department of Cardiology, Kocaeli - TurkeyMailing Address: Serdar Bozyel, Ibni Sina mh 41900 Derince Kocaeli. 41900, Kocaeli - Turkey. E-mail: seribra85@gmail.com, drserdarbozyel@gmail.com0520181105495496101120172202201822022018This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedKeywordsHeart Failure / physiopathologyTachycardia, VentricularHospitalizationDefibrillators Implantables
Dear Editor,
We read the article “Non-Sustained Ventricular Tachycardia (NSVT) Episodes Predict Future Hospitalization in ICD Recipients with Heart Failure” written by Uçar et al.1 with great interest. NSVT identified on routine ICD interrogation should be considered an important clinical event as the authors state in this article. However, we would like to bring attention to some issues related to the article.
NSVT was defined as 4 or more consecutive beats with a rate > 167 beats/min and shorter than 16 beats in this study. Both detection rate and number of intervals to detect (NID) ventricular tachycardia were slightly below the conventional interval (NID = 18/24) detection of VT/VF ≥ 188 bpm that have been proven effective.2,3 If we also include the new long-detection programming strategies (NID = 30/40) into this subject, we can say that the authors documented the increase in hospitalization, just only with slower and shorter episodes of NSVT.
Previously published reports showed that faster and longer runs of NSVT were more predictive than slower and shorter ones for adverse events.4 But, since there was no data about duration and rate of the NSVT episodes in the article, we could not establish an opinion about the importance of rate and duration of NSVT for predicting future hospitalizations.
More recently, the use of long-detection interval programming has received widespread acceptance based on several large randomized trials.3,5 With these new programming strategy, we believe that the prognostic value of NSVT will increase even more.
References1 Uçar FM, Yilmaztepe MA, Taylan G, Aktoz M. Non-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failure. Arq Bras Cardiol. 2017;109(4):284-9.UçarFMYilmaztepeMATaylanGAktozMNon-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failureArq Bras Cardiol201710942842892 Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, et al. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter defibrillators: Pain FREER x II Trial Results. Circulation. 2004;110(7):2591-6.WathenMSDeGrootPJSweeneyMOStarkAJOtternessMFAdkissonWOProspective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter defibrillators: Pain FREER x II Trial ResultsCirculation20041107259125963 Gasparini M, Proclemer A, Klerasy C, Kloppe A, Lunati M, Ferrer JB, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA. 2013;309(18):1903-11.GaspariniMProclemerAKlerasyCKloppeALunatiMFerrerJBEffect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trialJAMA.201330918190319114 Wang W, Lian Z, Rowin EJ, Maron BJ, Maron HS, Link MS. Prognostic implications of nonsustained ventricular tachycardia in high-risk patients with hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol. 2017;10(3):pii-e004604.WangWLianZRowinEJMaronBJMaronHSLinkMSPrognostic implications of nonsustained ventricular tachycardia in high-risk patients with hypertrophic cardiomyopathyCirc Arrhythm Electrophysiol.2017103e0046045 Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW, et al; PREPARE Study Investigators. 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. 2008;52(7):541-50.WilkoffBLWilliamsonBDSternRSMooreSLLuFLeeSWPREPARE Study InvestigatorsStrategic programming of detection and therapy parameters in implantable cardioverter defibrillators reduces shocks in primary prevention patients:results from the PREPARE (Primary Prevention Parameters Evaluation) studyJ Am Coll Cardiol2008527541550ReplyUçarFatih MehmetSincerely
Dear Editor,
We thank the journal readers for their great interest in our original article titled “Non-Sustained Ventricular Tachycardia Episodes Predict Future Hospitalization in ICD Recipients with Heart Failure” recently published in Arquivos Brasileiros de Cardiologia.1
In our study, we programmed ICD’s zones as ventricular tachycardia VT (167-200 bpm) with discriminators and VF (> 200 bpm). Non-sustained ventricular tachycardiaNSVT was defined in the monitored zone of ICD as 4 or more consecutive beats arising below the atrioventricular node with a rate > 167 beats/min and shorter than 16 beats. We used the number of intervals to detect (NID) ventricular tachycardia in VF zone or fast VT(FVT) zone. In our device program FVT zone was off NID was 18/24 in VF zone. If we programmed NID as 30/40, maybe we could detect more NSVTs, but in our analyses, we did not have any NSVT patients in VF (> 200 bpm) zone. All our patients were in VT (167-200 bpm) zone.
Finally, it is difficult to make a final decision according to our findings with a relatively limited study population. Hence, the new long-detection programming strategies need to be confirmed in further and larger prospective multicenter trials about the prognostic value of NSVT.
Sincerely, Fatih Mehmet UçarReference1 Uçar FM, Yilmaztepe MA, Taylan G, Aktoz M. Non-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failure. Arq Bras Cardiol. 2017;109(4):284-9.UçarFMYilmaztepeMATaylanGAktozMNon-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failureArq Bras Cardiol20171094284289Carta ao EditorSignificância Prognóstica da Taquicardia Ventricular Não-Sustentada Depende de sua Frequência e DuraçãoBozyelSerdarUniversity of Health and Sciences, Derince Training and Research Hospital, Department of Cardiology, Kocaeli - TurquiaCorrespondência: Serdar Bozyel, Ibni Sina mh 41900 Derince Kocaeli. 41900, Kocaeli - Turquia. E-mail: seribra85@gmail.com, drserdarbozyel@gmail.comPalavras-chaveInsuficiência Cardíaca / fisiopatologiaTaquicardia VentriculaHospitalizaçãoDesfibriladores Implantáveis
Caro Editor,
Lemos o artigo “Episódios de Taquicardia Ventricular não Sustentada (TVNS) predizem futura hospitalização em receptores de CDI com insuficiência cardíaca”, escrito por Uçar et al.,1 com grande interesse. A TVNS identificada na análise de rotina do CDI deve ser considerada um evento clínico importante, como afirmam os autores neste artigo. No entanto, gostaríamos de chamar a atenção para algumas questões relacionadas ao artigo.
A TVNS foi definida como 4 ou mais batimentos consecutivos com uma frequência >167 batimentos/min e menor que 16 batimentos neste estudo. Ambas a taxa de detecção e o número de intervalos para detectar (NID) taquicardia ventricular estavam ligeiramente abaixo do intervalo convencional (NID = 18/24) para detecção de TV/FV ≥ 188 bpm que se mostraram eficazes.2,3 Se incluirmos também as novas estratégias de programação de longa detecção (NID = 30/40) neste assunto, podemos dizer que os autores documentaram o aumento na hospitalização apenas com episódios mais lentos e curtos de TVNS.
Relatos publicados anteriormente mostraram que a apresentação mais rápida e mais longa da TVNS foi mais preditiva do que as mais lentas e mais curtas para eventos adversos.4 Mas, como não havia dados sobre a duração e a taxa dos episódios de TVNS no artigo, não pudemos estabelecer uma opinião sobre a importância da frequência e duração da TVNS para prever futuras hospitalizações.
Mais recentemente, o uso de programação com longo intervalo de detecção tem sido amplamente aceito com base em vários grandes ensaios randomizados.3,5 Com essa nova estratégia de programação, acreditamos que o valor prognóstico da TVNS aumentará ainda mais.
Carta-respostaUçarFatih MehmetAtenciosamente
Caro Editor,
Agradecemos aos leitores da revista por seu grande interesse em nosso artigo original intitulado “Episódios de Taquicardia Ventricular não Sustentada predizem futura hospitalização em receptores de CDI com Insuficiência Cardíaca”, recentemente publicado nos Arquivos Brasileiros de Cardiologia.1
Em nosso estudo, programamos as zonas do CDI como taquicardia ventricular, TV, (167-200 bpm) com discriminadores e FV (> 200 bpm). A Taquicardia ventricular não sustentada, TVNS, foi definida na zona monitorada do CDI como 4 ou mais batimentos consecutivos originando-se abaixo do nó atrioventricular, com frequência >167 batimentos/min e menor que 16 batimentos.
Utilizamos o número de intervalos para detectar (NID) taquicardia ventricular na zona de FV ou na zona de TV rápida (TVR). No programa de nosso dispositivo, a zona de TVR estava fora do NID, sendo 18/24 na zona de FV. Se programássemos o NID como 30/40, talvez pudéssemos detectar mais TVNS, mas em nossas análises, não tivemos nenhum paciente TVNS na zona de FV (> 200 bpm). Todos os nossos pacientes estavam em zona de TV (167-200 bpm).
Finalmente, é difícil tomar uma decisão final de acordo com nossos achados tendo uma população de estudo relativamente limitada. Assim, as novas estratégias de programação de detecção longa precisam ser confirmadas em futuros e maiores estudos multicêntricos prospectivos sobre o valor prognóstico da TVNS.