Device programing and SMART pass algorithm activation in subcutaneous implantable defibrillator patients: Data from a...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Subcutaneous implantable cardioverter-defibrillator (S-ICD) programming in clinical practice remains understudied.
• The activation status of the SMART Pass filter, designed to reduce inappropriate shocks, is a key area of investigation.

Purpose of the Study:

• To assess device programming during follow-up in S-ICD recipients.
• To evaluate the rate of detected arrhythmias in S-ICD patients.

Main Methods:

• Analysis of data from 670 S-ICD patients across 17 Italian centers, followed remotely for a median of 31 months.
• Investigation of the impact of the enhanced SMART Pass version, introduced in October 2022, on unintentional deactivation rates.

Main Results:

• SMART Pass was enabled in 87% of patients, with median conditional and shock zone cut-offs at 210 bpm and 250 bpm, respectively.
• SMART Pass activation was associated with significantly lower rates of shocks (0.12 vs. 0.20/patient-year) and untreated arrhythmias (0.12 vs. 0.23/patient-year).
• The enhanced SMART Pass version demonstrated a lower deactivation rate (0.04 vs. 0.14/patient-year) and reduced treated and untreated arrhythmias.

Conclusions:

• S-ICD devices are typically programmed to detect high ventricular rates to minimize inappropriate shocks.
• SMART Pass activation is linked to reduced rates of detected and treated arrhythmias.
• The enhanced SMART Pass version appears to decrease deactivation rates and further reduce treated arrhythmias.