SVT discrimination algorithms significantly reduce the rate of inappropriate therapy in the setting of modern‐day delayed high‐rate detection programming

Abstract

Background Contemporary implantable cardioverter‐defibrillator (ICD) programming involving delayed high‐rate detection and use of supraventricular tachycardia (SVT) discriminators has significantly reduced the rate of inappropriate shocks. The extent to which SVT algorithms alone reduce inappropriate therapies is poorly understood. Methods and Results PainFree SST enrolled 2770 patients with a single‐ or dual‐chamber ICD or cardiac resynchronization defibrillator. Patients were followed for 22 ± 9 months with SVT discriminators on in 96% of patients. Sustained ventricular tachyarrhythmias and SVT episodes were adjudicated by an independent physician committee. For this analysis, all episodes were subjected to postprocessing computer simulation with SVT discriminators off with and without delayed high‐rate detection criteria (ventricular fibrillation zone only, 30/40 at 320 ms). There were 3282 adjudicated SVT episodes of which 115 resulted in an ICD shock and 113 received only ATP (2‐year inappropriate shock and therapy rates of 3.1% and 4.1%). Therapy was appropriately withheld for the remaining 3054 SVT episodes. With both SVT discriminators and delayed high‐rate detection simulated off, the 2‐year inappropriate therapy rate would have been 22.9% (hazard ratio [HR] = 6.24; 95% confidence interval [CI]: 5.20‐7.49). With SVT discriminators simulated off and delayed high‐rate detection simulated on in all patients, the 2‐year rate would have been 6.4% (HR = 1.63; CI: 1.44‐1.85). Conclusions The use of SVT discriminators has a significant role in reducing the rate of inappropriate ICD therapy even in the setting of delayed high‐rate detection settings. Deactivating SVT discriminators would have resulted in an overall increase in the inappropriate ICD therapy rate by 63% and 524% with and without delayed high‐rate detection programming, respectively.

Driving restriction in patients with cardiac implantable electronic devices: an overview of worldwide regulations

“…Regarding inappropriate ICD shocks, the prevalence reported in major trials (60)(61)(62)(63) ranges between 11% and 32%, although this is largely outdated in newer studies applying upto-date programming and arrhythmia discriminators, showing a two-years inappropriate shock rate of 3% (64,65). Inappropriate ICD therapies may have a proarrhythmic effect (66, 67), but the associated incidence of syncope is little unknown yet.…”

Trends in implantable cardioverter-defibrillator programming practices and its impact on therapies: Insights from a North American Remote Monitoring Registry 2007–2018

“…Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients at high risk of ventricular arrhythmias [1][2][3] . Previous ICD programming trials, such as Primary Prevention Parameters Evaluation (PREPARE), Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) and Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III (ADVANCE-III), demonstrated that shock reduction strategies not only reduce shock rates but can also reduce hospitalizations and mortality over a follow-up period of up to 14 months [4][5][6][7][8][9][10] .…”

Successful Identification of and Discrimination Between Atrial and Ventricular Arrhythmia with the Aid of Pacing and Defibrillator Devices

“…[ 6 ] With contemporary programming of ICDs with delayed high-rate detection and the use of SVT discriminators, the rates of inappropriate shock and therapy can be reduced to around 3–4%. [ 7 ]…”