Programming ICDs in the Modern Era beyond Out-of-the Box Settings

Implantable cardioverter-defibrillators (ICDs) improve survival when used as primary or secondary prevention therapy in patients with a broad spectrum of disorders associated with a high risk of sudden death. As indications continue to be refined, attention has increasingly turned to ICD-related complications and their impact on quality of life. Foremost among these complications are inappropriate shocks. This issue remains a major challenge, despite technological advances with sophisticated recording capabilities and detection algorithms. While pharmacological and catheter-based interventions represent important adjunctive tools for the reduction of inappropriate shocks, this contemporary review focuses on customizing and optimizing ICD programming. Studies addressing ICD programming beyond "out the box" settings are reviewed for each device manufacturer and special circumstances are considered. We discuss the benefits and pitfalls of strategies such as high cutoff rates, longer detections times, antitachycardia pacing, and discriminators in reducing the incidence of inappropriate shocks and offer practical programming tips.