Predictors of Atrial High-Rate Episodes and Inappropriate Device Therapy in Implantable Cardioverter Defibrillators

Area of Science:

• Cardiology
• Medical Devices
• Predictive Analytics

Background:

• Implantable cardioverter defibrillator (ICD) therapy prevents sudden cardiac death but carries risks like inappropriate device therapy (IDT).
• ICDs can also serve as early warning systems for atrial arrhythmias.
• IDT is associated with adverse outcomes and reduced quality of life.

Purpose of the Study:

• To identify pre-implant clinical parameters that predict the risk of inappropriate device therapy (IDT).
• To predict which patients are likely to develop atrial high-rate episodes (AHRE).

Main Methods:

• A prospective registry of 413 patients receiving an ICD with an atrial lead between 2010 and 2019.
• Univariate and multivariate Cox regression analyses were performed on 40 pre-implant parameters.
• Predictive models were developed using Harrell's C-index to assess performance.

Main Results:

• A predictive model for IDT (C-index 0.785) identified secondary prevention ICD, ischemic CMP, unclassified CMP, and diuretic use as risk factors, with MRA use and diabetes as protective factors.
• Atrial fibrillation (AF) was surprisingly not a predictor of IDT.
• A separate model for AHRE development (C-index 0.663) included age, LVEF, hypertrophic CMP, family history of CVD, and hypercholesterolemia.

Conclusions:

• Six pre-implant factors were identified that influence the risk of inappropriate device therapy (IDT).
• Five additional factors were identified as risk factors for developing atrial high-rate episodes (AHRE).
• Pre-implant assessment of these variables can better inform patients about the potential benefits and risks of ICD therapy.