ADVANCE CRT - D: Antitachycardia Pacing (ATP) Delivery for Painless Implantable Cardioverter Defibrillator (ICD) Therapy (ADVANCE-CRTD)

• Compare Efficacy of the First BiV and RV ATP to Terminate FVT [ Time Frame: one year ] [ Designated as safety issue: No ]
• Compare Efficacy of the First BiV and RV ATP to Terminate Slow VT [ Time Frame: one year ] [ Designated as safety issue: No ]
• Compare Efficacy of BiV and RV ATP (All ATP Therapies) to Terminate Slow VT [ Time Frame: one year ] [ Designated as safety issue: No ]
• Determine the Rate of Both FVT and VT Episodes Which Are Accelerated or Degenerates Into VF [ Time Frame: one year ] [ Designated as safety issue: No ]

• Compare efficacy of:
• the first BiV and RV ATP to terminate FVT
• the first BiV and RV ATP to terminate slow VT
• BiV and RV ATP (all ATP therapies) to terminate slow VT
• Determine the rate of both FVT and VT episodes which are accelerated or degenerates into VF

To compare the efficacy of RV and BiV ATP for the termination of ventricular arrhythmias in patients who are candidates to a cardiac resynchronisation therapy (CRT) and have a Class I or IIA indication for ICD implantation.

The hypothesis of delivering ATP from different sites (RV or BIV) has never been evaluated in a prospective, controlled and randomized study.

Main objective: Compare efficacy of ATP therapy (Burst, 8 pulses, 88 %, 1 sequence) to terminate all types of ventricular tachycardia (all VTs (FVT+VT)) when delivered in the right ventricle (RV) only versus both ventricles (BiV) resulting in a 10 % difference in favour of BIV ATP

Secondary objectives:

• Compare efficacy of the first BiV and RV ATP (Burst, 8 pulses, 88 %) to terminate fast ventricular tachycardia (FVT)
• Compare efficacy of the first BiV and RV ATP (Burst, 8 pulses, 88 %) to terminate slow ventricular tachycardia (slow VT)
• Compare efficacy of BiV and RV ATP (all ATP therapies) to terminate slow ventricular tachycardia (slow VT)
• Determine the rate of both FVT and VT episodes which are accelerated or degenerates into VF

• Tachycardia, Ventricular
• Ventricular Fibrillation

• Experimental: BiV
  ATP therapies are delivered in both the ventricles
  Intervention: Device: Implantable Cardiac Defibrillator
• Active Comparator: RV
  ATP delivered only in the right ventricle
  Intervention: Device: Implantable Cardiac Defibrillator

• Schwab JO, Gasparini M, Anselme F, Mabo P, Peinado R, Lavergne T, Bocchiardo M, Mascioli G, Passardi M, Mainardis M. Right ventricular versus biventricular antitachycardia pacing in the termination of ventricular tachyarrhythmia in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D trial. J Cardiovasc Electrophysiol. 2006 May;17(5):504-7.
• Gasparini M, Anselme F, Clementy J, Santini M, Martínez-Ferrer J, De Santo T, Santi E, Schwab JO; ADVANCE CRT-D Investigators. BIVentricular versus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D Trial. Am Heart J. 2010 Jun;159(6):1116-1123.e2.

Inclusion Criteria:

• CRT + ICD indications (Class I-IIA) according to the guidelines
• Patients have been implanted with a Medtronic Marquis Family ICD capable of RV-ATP or BIV-ATP
• Patients in chronic AF who undergo a complete AV ablation and that the complete AV block is confirmed at PHD

Exclusion Criteria:

• Patient's life expectancy less than 1 year due to a non cardiac chronic disease
• Patient on heart transplant list which is expected in < 1 year
• Patient's age less than 18 years
• Replacements and upgrades
• Epicardial lead
• Mechanical tricuspid valve
• Ventricular Tachyarrhythmias associated with reversible causes
• Unwillingness or inability to provide written informed consent
• Enrollment in, or intention to participate in, another clinical study during the course of this study
• Inaccessibility for follow-up at the study center