Effects of a rate smoothing algorithm for prevention of ventricular arrhythmias: Results of the Ventricular Arrhythmia Suppression Trial (VAST)

Paul Andrew Friedman, Sohail Jalal, Scott Kaufman, Rollo Villareal, Scott Brown, Stephen J. Hahn, Darin R. Lerew

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: 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. Objectives: 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. Methods: 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. Results: Of enrolled patients, 281 were randomized to RS Off followed by RS On, and 288 to RS On followed by RS Off. With RS On, 75 (23%) patients experienced a reduction in arrhythmias, 76 (23%) saw an increase in arrhythmias, and the remaining 176 (54%) had no difference. No significant difference (P = .58) in frequency of arrhythmias with RS On vs RS Off was found. Conclusion: Rate smoothing does not result in a reduction in ventricular arrhythmias in a heterogenous population of patients receiving ICDs.

Original languageEnglish (US)
Pages (from-to)573-580
Number of pages8
JournalHeart Rhythm
Volume3
Issue number5
DOIs
StatePublished - May 2006

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Cardiac Arrhythmias
Implantable Defibrillators
Torsades de Pointes
Long QT Syndrome
Tachycardia
Cross-Over Studies
Population
Incidence

Keywords

  • Rate smoothing
  • Rate-dependent arrhythmia
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effects of a rate smoothing algorithm for prevention of ventricular arrhythmias : Results of the Ventricular Arrhythmia Suppression Trial (VAST). / Friedman, Paul Andrew; Jalal, Sohail; Kaufman, Scott; Villareal, Rollo; Brown, Scott; Hahn, Stephen J.; Lerew, Darin R.

In: Heart Rhythm, Vol. 3, No. 5, 05.2006, p. 573-580.

Research output: Contribution to journalArticle

Friedman, Paul Andrew ; Jalal, Sohail ; Kaufman, Scott ; Villareal, Rollo ; Brown, Scott ; Hahn, Stephen J. ; Lerew, Darin R. / Effects of a rate smoothing algorithm for prevention of ventricular arrhythmias : Results of the Ventricular Arrhythmia Suppression Trial (VAST). In: Heart Rhythm. 2006 ; Vol. 3, No. 5. pp. 573-580.
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