Efficacy of Long Detection Interval Implantable Cardioverter-Defibrillator Settings in Secondary Prevention Population

Abstract

Background-Three trials demonstrated recently that a long detection window reduces implantable cardioverter-defibrillator (ICD) therapy in primary prevention patients. Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III (ADVANCE III) was the only trial that enrolled both primary and secondary prevention patients. Methods and Results-Of the 1902 patients enrolled in the ADVANCE III trial, 477 received a defibrillator for secondary prevention; 248 patients were randomly assigned to a long detection setting (30 of 40 intervals) and 229 to the nominal setting (18 of 24 intervals) for ventricular arrhythmias with cycle length ≤320 ms. Eight-five percent of patients were men, with a mean age of 65±12 years, a previous history of ventricular fibrillation in 37% of the cases, and a mean ejection fraction of 38±13%. The ICD device mix was 37% single chamber, 47% dual chamber, and 16% triple chamber. Over a median period of 12 months, the long detection period was associated with a 25% reduction in the number of overall therapies (115.6 versus 86.8 per 100 patient-years; incidence rate ratio, 0.75; 95% confidence interval, 0.

Effect of Cardiac Rehabilitation in Preventing Implantable Cardioverter Defibrillator Therapy in Patients with Reduced Left Ventricular Ejection Fraction

“…The findings of the Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients ADVANCE trial 10,11 also support the findings of the present study. Specifically, that the trial indicated that programming long detection intervals reduced the number of inappropriate shocks, but did not reduce mortality 10,11 .…”

“…Conversely, one study has demonstrated that appropriate or inappropriate shocks are one of the risk factors for prognosis 7 , and subanalysis of data from MADIT-and SCD-HeFT showed a two-fold increased risk of death in patients who experienced inappropriate ICD shocks 8,9 . New strategies, changing the detection time and zone for ventricular arrhythmia, have been proposed to reduce inappropriate shocks [10][11][12][13] .…”

“…Specifically, that the trial indicated that programming long detection intervals reduced the number of inappropriate shocks, but did not reduce mortality 10,11 .…”

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…However, the ADVANCE III Secondary Prevention substudy confirmed the safety of not programming therapy for rates patient-years [105]. Previously published recommendations suggest a VT zone starting at 10 to 20 bpm slower than the observed tachycardia rate, usually including a 2-or 3-zone arrhythmia detection scheme (as discussed elsewhere) [106].…”

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

“…56,57 These studies had a significant impact on ICD programming strategies, and spawned a number of similar studies examining variations on lenient programming practices. Several studies have examined high rate programming, 58,59 while others have considered prolonged detection, [60][61][62][63][64][65] or a combination of these two approaches. 66,67 In general, lenient programming practices in these studies have demonstrated a decrease in the rate of appropriate and inappropriate shocks, with either a decrease in overall mortality or no difference, when compared to conventional programming practices.…”