Low inappropriate shock rates in patients with single- and dual/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results

Abstract

In a large patient cohort receiving ICDs for primary or secondary prevention, the adoption of novel enhanced detection algorithms in conjunction with routine implementation of modern programming strategies led to a very low inappropriate shock rate.

Shock rates in an unselected real world cohort of patients with medtronic protecta implantable cardioverter defibrillators

“…The results confirm in a large real world population, the low inappropriate shock rates described in PainFree SST study [10]. Our study differs from both Advance III [9] and MADIT-RIT [4] in that it represents data from an unselected "real world" population and we report "shock data" and not therapy data (i.e., composite shock +ATP).…”

“…Patients with prior atrial fibrillation (AF) and prior slow ventricular tachycardia(VT) were included. defined as number of intervals to detect(NID) programmed to 30 out of 40 beats and above [8][9][10]. The time to event of appropriate and inappropriate shocks was analysed according to the method of Kaplan-Meier.…”

“…In addition to device discrimination algorithms, non-committed shocks and anti-tachycardia pacing(ATP) [6] there is now increasing emphasis on strategic programming [7,8] and delayed treatment to avoid unnecessary and inappropriate shocks [4,9]. Contemporary data suggest that the incidence of inappropriate shocks may be much lower [10,11] than historically suggested. Real world data regarding the risks of shocks is important to counsel patients accurately at ICD implant; this data however, is currently lacking.…”

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…Recent data from PainFree SST notes very low rates of inappropriate shocks (3.7% for single chamber; 2.8% for dual and triple chamber after 2 years). The choice of device was not randomized, suggesting that when physicians chose a dual-or triple-chamber device (perhaps due to known atrial arrhythmia or bradycardia), inappropriate shock rates were minimized [136]. The Optimal Anti-Tachycardia Therapy in Implantable Cardioverter-Defibrillator Patients Without Pacing Indications (OPTION) trial randomized 462 patients to single-or dual-chamber programming and noted inappropriate shock rates of 10.3% for single chamber vs 4.3% for dual chamber after 27 months (P¼ .015).…”

176-54: Characteristics and Outcomes of Diabetic Patients with an Implantable Cardioverter Defibrillator in a Real World Setting: Results From the Israeli ICD Registry

“…DM is a risk factor for development of atrial fibrillation [7,13,[36][37][38] and indeed, more of our patients had atrial fibrillation (Table 1), a major cause of inappropriate shocks, and it would be anticipated that the rate of inappropriate shocks would be increased. Evidence based programming of these devices has greatly decreased the rate of inappropriate therapies especially in diabetics [14] and indeed several centers contributing to the registry were participants in successful programming trials during the course of follow up, which may explain why there was no difference in the rate of inappropriate therapies [14,39].…”