Abstract
Rate smoothing, which is available in some pacemakers and implantable cardioverter defibrillators (ICDs), has been used to prevent Torsades de Pointes in patients with long QT syndrome. Its efficacy in general ventricular arrhythmia prevention has not been determined. The purpose of the Ventricular Arrhythmia Suppression Trial (VAST) was to prospectively investigate whether rate smoothing could significantly reduce the incidence of ventricular tachyarrhythmias in a large, broad population of patients with ICDs. Five hundred sixty-nine patients were enrolled at 57 participating centers and implanted with a commercially available Guidant ICD. A single-blinded crossover design was used in which each patient was randomized at implant to one of two treatment sequences: either rate smoothing on (RS On) followed by rate smoothing off (RS Off), or RS Off followed by RS On. This mode sequence was randomly determined and assigned in a 1:1 fashion using randomized permuted blocks by site. Each mode was followed for 6 months. Programming of rate smoothing was prescribed as 12% Down and 12% Up for the duration of the RS On period. Of enrolled patients, 281 were randomized to RS Off followed by RS On, and 288 to RS On followed by RS Off. Wit...Continue Reading
References
Jan 1, 1989·American Heart Journal·A Bayés de LunaJ F Leclercq
Sep 15, 1988·The New England Journal of Medicine·W D WeaverA P Hallstrom
Jan 1, 1994·Journal of the American College of Cardiology·M RoelkeJ N Ruskin
Oct 1, 1995·Journal of Cardiovascular Electrophysiology·F E MarchlinskiM Preminger
Feb 3, 1998·European Heart Journal·U MeyerfeldtR Dietz
Jun 9, 1998·Heart·S ViskinY Copperman
Sep 30, 2000·American Heart Journal·G A LamasL Goldman
Nov 3, 2000·Current Cardiology Reports·S Viskin, R Fish
Nov 21, 2000·The American Journal of Cardiology·S ViskinL A Saxon
Mar 22, 2002·The New England Journal of Medicine·Arthur J MossUNKNOWN Multicenter Automatic Defibrillator Implantation Trial II Investigators
Jan 11, 2003·Pacing and Clinical Electrophysiology : PACE·Gerian C GrönefeldUNKNOWN WorldWide Gem DR Study Group
May 21, 2004·The New England Journal of Medicine·Michael R BristowUNKNOWN Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators
May 21, 2004·The New England Journal of Medicine·Alan KadishUNKNOWN Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators
Jan 22, 2005·The New England Journal of Medicine·Mark B McClellan, Sean R Tunis
Apr 27, 2005·Heart Rhythm : the Official Journal of the Heart Rhythm Society·T Jared BunchDouglas L Packer
Citations
Nov 13, 2009·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Siva K MulpuruCesare Saponieri
Feb 13, 2009·Expert Review of Cardiovascular Therapy·Mithilesh Das
Aug 29, 2012·Heart, Lung & Circulation·Matthew R Webber, Martin K Stiles
Nov 9, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Paul Khairy, Fadi Mansour
Sep 2, 2009·Pacing and Clinical Electrophysiology : PACE·Mithilesh K DASHillel A Steiner
Feb 12, 2009·Journal of Cardiovascular Electrophysiology·Jan NemecPaul A Friedman
Jun 22, 2010·Journal of Cardiovascular Electrophysiology·Peter OosterhoffMarc A Vos
Mar 1, 2012·Pacing and Clinical Electrophysiology : PACE·Savvas NikolidakisMichael Glikson
Feb 10, 2011·Pacing and Clinical Electrophysiology : PACE·Fadi Mansour, Paul Khairy
Jul 24, 2014·Pacing and Clinical Electrophysiology : PACE·Philippe MauryBenoit Hallier
Mar 25, 2014·Journal of Cardiovascular Electrophysiology·Cathrin TheisThomas Rostock
May 2, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·David J Wilber
Aug 19, 2007·Journal of the American College of Cardiology·Michael O SweeneyTodd Sheldon
May 9, 2008·Revista española de cardiología·Mauricio AbelloCarlos Labadet
Oct 8, 2015·The Cochrane Database of Systematic Reviews·David A McNamaraMark D Huffman
Oct 20, 2011·Circulation. Arrhythmia and Electrophysiology·Jayanthi N KoneruKenneth A Ellenbogen
Mar 2, 2011·Circulation·Charles SwerdlowRaja N Ghanem
Aug 7, 2013·Circulation·Malini Madhavan, Paul A Friedman
Jun 2, 2017·Herzschrittmachertherapie & Elektrophysiologie·Mate VamosStefan H Hohnloser