The Lead Episode 176: A Discussion of the One Year Outcomes of the Modular ATP Trial-The Lead Episode 176 Video

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Video Summary

The Modular ATP trial evaluated a Boston Scientific system pairing a subcutaneous ICD with an Empower leadless pacemaker to deliver antitachycardia pacing (ATP). This prospective, multinational, single-arm study enrolled 297 patients; 286 received the system. Participants had an ICD indication and elevated risk of monomorphic VT, and about half already had a subcutaneous ICD.<br /><br />Implantation was successful in all attempted patients. At one year, ATP terminated roughly two-thirds of treated monomorphic VT episodes, with first-attempt success around 60%; approximately 10% of episodes accelerated. Inappropriate shocks occurred in 8.5%, and 5.3% of ATP requests failed to communicate to the pacemaker. The study had no comparator, and its cohort was enriched for arrhythmias, limiting conclusions about shock reduction or broader use. Discussants viewed the system as promising but not ready for routine use, citing communication failures, inappropriate shocks, and the need for comparative studies and longer-term follow-up.

Keywords

Modular ATP trial

subcutaneous ICD

leadless pacemaker

antitachycardia pacing

monomorphic VT