Transcutaneous magnetic stimulation may safely reduce the burden of ventricular tachycardia (VT) during VT storm, according to results of a randomized clinical trial, published in JAMA Cardiology.

Patients (N=26) with 3 or more episodes of sustained VT in 24 hours were recruited for the Magnetic Stimulation to Treat VT Storm (STAR-VT; Clinicaltrials.gov identifier: NCT04043312) trial at the Hospital of the University of Pennsylvania between 2019 and 2021. Patients were randomly assigned 1:1 to receive a single session of transcutaneous magnetic stimulation or sham stimulation. Transcutaneous magnetic stimulation was delivered for 60 minutes at 80% of the monitor threshold at a frequency of 0.9 Hz. Patients were monitored for vital signs and via a 12-lead electrocardiogram. The primary outcome was freedom from sustained VT for 24 hours after randomization.

Patients in the intervention and sham cohorts were aged mean 66.9 (standard deviation [SD], 15.2) and 61.7 (SD, 10.6) years; 71% and 83% were men; 1.9 (SD, 0.5) and 2.2 (SD, 0.72) were taking antiarrhythmic drugs; 71% and 50% had coronary artery disease; 57% and 67% had hypertension; 29% and 50% had atrial fibrillation; and 71% and 50% had monomorphic VT, respectively. The number of VT episodes in the preceding 24 hours was 11.0 (SD, 8.7) and 14.8 (SD, 11.9), respectively.


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VT recurred in the 24 hours after treatment among 29% of transcutaneous magnetic stimulation and 58% of sham recipients (P =.20).

During the 72-hour post-treatment period, VT occurred an average of 4.5 (SD, 7.2) times in the transcutaneous magnetic stimulation group and 10.7 (SD, 13.8) times in the sham group (incidence rate ratio [IRR], 0.42; P <.001). Stratified by the first and second 24 hours after treatment, VT occurred fewer times among transcutaneous magnetic stimulation recipients in the first 24 hours (IRR, 0.18; P <.001) but not the second 24 hours (IRR, 0.88; P =.60).

At 24 hours, transcutaneous magnetic stimulation recipients reduced their antiarrhythmic drug intake (mean, 1.8 vs 0.9 drugs; P =.001) and the sham group did not (mean, 1.9 vs 2.3 drugs; P =.20).

No safety concerns were reported.

This study was underpowered to detect significant differences in the primary outcome.

“In this randomized clinical trial of patients with VT storm, results demonstrated that [transcutaneous magnetic stimulation] has the potential to safely reduce the burden of VT,” the study authors wrote. “These findings should inform future investigations of the optimal strategies for [transcutaneous magnetic stimulation].”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Markman TM, Pothineni NVK, Zghaib T, et al. Effect of transcutaneous magnetic stimulation in patients with ventricular tachycardia storm: A randomized clinical trial. JAMA Cardiol. Published online February 16, 2022. doi:10.1001/jamacardio.2021.6000