Safety and efficacy of high-rate cutoff and long detection interval ICD programming in secondary prevention patients

Abstract

Several trials demonstrated that a long detection interval and a high-rate cutoff reduced implantable cardioverter-defibrillator (ICD) therapy in primary prevention patients. However, only a few data are available for secondary prevention (SP) patients. The aim of this study was to evaluate whether these ICD programming would be effective in reducing ICD therapies in SP patients. We enrolled 65 SP patients under ICD or cardiac resynchronization therapy with the defibrillator programmed with the same setting (conventional setting). During follow-up, we changed detection rates in each zone; cycle length (CL) ≤400 to ≤370 ms for ventricular tachycardia (VT) zone, CL ≤350 to ≤320 ms for fast VT zone, CL ≤300 to ≤270 ms for ventricular fibrillation (VF) zone, and number of intervals to detect ventricular tachyarrhythmia in VF zone: 12-24. We retrospectively compared the incidences of ICD therapies, syncope, and hospitalization due to slow VT under the detection rate between both settings. Median follow-up periods were 5.0 (interquartile range 2.5-7.8) and 2.5 years (interquartile range 2.3-2.7) in conventional and strategic settings, respectively. The incidence of appropriate ATP and shock significantly decreased in strategic setting (conventional and strategic settings: 21.2 and 4.8 ATPs per year, respectively, OR 0.18, 95 % CI 0.06-0.54, p = 0.002, 26.1 and 7.8 shocks per year, respectively, OR 0.29, 95 % CI 0.09-0.88, p = 0.03). The incidence of overall inappropriate therapy significantly decreased (conventional and strategic settings: 17.6 and 2.8 therapies per year, respectively, OR 0.14, 95 % CI 0.05-0.44, p = 0.01). The incidence of syncope and slow VT was not significantly different between both settings. In conclusion, ICD programming-combined long detection interval with high-rate cutoff was effective in reducing appropriate shock and inappropriate therapy without increasing the incidence of syncope and slow VT in SP patients.

Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality

“…The mortality rate was also significantly lower in patients with NP after stratifying for primary and secondary prevention (8.2% vs. 20.9% in was presented. 19 The current study confirmed and expanded the available information regarding ICD programming in patients with secondary prevention ICD indication. Of the whole study population, 74% were programmed with conventional and 26% with novel programming.…”

“…requiring secondary prevention is scarce. 18,19 After the introduction of these novel programming strategies, we developed an institutional device programming standard combining different aspects of these suggested strategies. Here, we present the long-term effects of this novel programming strategy on the mortality and morbidity rate in a large real-life cohort, which consists of patients with primary and secondary ICD indication.…”

“…In the literature, there is a subgroup analysis of the ADVANCE III trial and a small study by Hayashi et al dealing with secondary prevention patients and new programming strategies. 18,19 Regarding the ADVANCE III trial, of the 1,902 patients enrolled, 477 were ICD recipients due to secondary prevention, with a median follow-up period of 12 months. There were significantly fewer appropriate shocks in the long detection arm (30/40 NID) compared to standard arm (18/24 NID), but the rate of appropriate ATP therapies was not different in both groups.…”

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

“…Several studies have examined high rate programming, 58,59 while others have considered prolonged detection, [60][61][62][63][64][65] or a combination of these two approaches. 66,67 In general, lenient programming practices in these studies have demonstrated a decrease in the rate of appropriate and inappropriate shocks, with either a decrease in overall mortality or no difference, when compared to conventional programming practices. These practices have been further solidified in two meta-analyses, which found lenient programming practices were associated with a reduction in mortality and IS rates without an increase in syncope.…”

Implantable Cardioverter Defibrillator Tachycardia Therapies: Past, Present and Future Directions

“…Metanalyses of these trials showed a mortality benefit with no increase in risk of syncope [ 126 , 127 ]. Similarly, a study focusing on secondary prevention patients showed that setting a high-rate cut-off and a long detection interval reduced appropriate and inappropriate therapies without increasing the incidence of syncope and slow VT [ 128 ]. On the other hand, case reports have shown undiagnosed slow VT manifesting as heart failure with worsening LV impairment and respiratory failure [ 129 ], as well as acute liver failure [ 130 ].…”