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Long-term follow-up on high-rate cut-off programming for implantable cardioverter defibrillators in primary

Nicolas Clementy1, Bertrand Pierre, Bénédicte Lallemand

  • 1Cardiology B Department, Service de Cardiologie B, Trousseau Hospital, François Rabelais University, 37044 Tours, France. nclementy@yahoo.fr

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 6, 2012
PubMed

Insights

High-rate cut-off programming for implantable cardioverter defibrillators (ICDs) in patients with reduced ejection fraction is safe long-term. This approach significantly lowers ICD shocks, which can be harmful in this population.

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Implantable cardioverter defibrillators (ICDs) reduce mortality in patients with left ventricular systolic dysfunction.
  • High-rate cut-off programming may decrease ICD therapies but its long-term impact is unclear, leading to underutilization.

Purpose of the Study:

  • To evaluate the safety and efficacy of high-rate cut-off (220 b.p.m.) shock-only ICD programming in primary prevention patients.
  • To assess the long-term consequences of this programming strategy on morbidity and mortality.

Main Methods:

  • Prospective study of 365 patients with cardiomyopathy and left ventricular dysfunction receiving an ICD for primary prevention.
  • Devices programmed with a shock-only zone >220 b.p.m. and a monitoring zone of 170-220 b.p.m.
  • Median follow-up of 40 months.

Main Results:

  • 41 patients (11.2%) received appropriate shocks; 24 (6.6%) received inappropriate shocks.
  • 84% of patients experienced no ICD shocks during follow-up.
  • Ventricular tachycardia episodes were recorded in the monitoring zone in 11.8% of patients, with only 1.9% symptomatic.

Conclusions:

  • High-rate cut-off (220 b.p.m.) shock-only ICD programming is safe in the long term for primary prevention patients with reduced ejection fraction.
  • This strategy results in a very low rate of ICD discharges, avoiding potentially deleterious shocks in this vulnerable population.
Abstract

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