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Published on: February 28, 2012
Safety and efficacy of high-rate cutoff and long detection interval ICD programming in secondary prevention patients
Yusuke Hayashi1, Masahiko Takagi2, Jun Kakihara1
1Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Insights
Optimizing implantable cardioverter-defibrillator (ICD) programming with longer detection intervals and higher rate cutoffs significantly reduced ICD therapies in secondary prevention patients. This strategic adjustment lowered both appropriate and inappropriate shocks without increasing syncope or slow ventricular tachycardia events.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable cardioverter-defibrillator (ICD) therapy optimization is crucial for primary prevention patients.
- Limited data exist on the efficacy of advanced ICD programming in secondary prevention (SP) patients.
- Current programming strategies may not be optimal for reducing unnecessary therapies in SP populations.
Purpose of the Study:
- To evaluate the effectiveness of a strategic ICD programming approach in reducing therapies for secondary prevention patients.
- To assess whether a long detection interval and high-rate cutoff strategy can decrease ICD shocks and antitachycardia pacing (ATP) in SP patients.
- To determine if this programming change impacts the incidence of syncope or hospitalization due to slow ventricular tachycardia (VT).
Main Methods:
- A retrospective study involving 65 SP patients with ICDs or cardiac resynchronization therapy with a defibrillator (CRT-D).
- Patients' devices were initially programmed with a conventional setting and later switched to a strategic setting with adjusted detection rates (e.g., VT zone CL ≤370 ms, VF zone CL ≤320 ms, VF zone intervals 12-24).
- Incidences of ICD therapies (ATP, shocks), syncope, and slow VT hospitalizations were compared between the conventional and strategic programming settings.
Main Results:
- The strategic ICD programming significantly decreased the incidence of appropriate ATP and shocks per year compared to the conventional setting (ATP: 21.2 vs 4.8; Shocks: 26.1 vs 7.8).
- Overall inappropriate therapy incidence was significantly reduced with the strategic setting (17.6 vs 2.8 therapies per year).
- No significant difference was observed in the incidence of syncope or slow VT hospitalizations between the two programming strategies.
Conclusions:
- Strategic ICD programming, combining a long detection interval with a high-rate cutoff, effectively reduces appropriate and inappropriate therapies in secondary prevention patients.
- This programming approach is safe, as it does not increase the risk of syncope or slow VT events.
- Optimized ICD programming represents a valuable tool for improving patient outcomes and device management in the SP population.
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.
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