Impact of Programming Strategies Aimed at Reducing Nonessential Implantable Cardioverter Defibrillator Therapies on Mortality

Abstract

Background-Patients who receive implantable cardioverter defibrillator therapies are at higher risk of death versus those who do not. Programmed settings to reduce nonessential implantable cardioverter defibrillator therapies (therapy reduction programming) have been developed but may have adverse effects. This systematic review and meta-analysis assessed the relationship between therapy reduction programming with the risks of death from any cause, implantable cardioverter defibrillator shocks, and syncope. Methods and Results-MEDLINE, EMBASE, and clinicaltrials.gov databases were searched to identify relevant studies.Those that followed patients for ≥6 months and reported mortality were included. Most (77%) participants were men, had a history of ischemic heart disease (56%), and were prescribed β-blockers (84%). Therapy reduction programming was associated with a 30% relative reduction in mortality (95% confidence interval, 16%-41%; P<0.001). No significant heterogeneity among studies was observed (P=0.6). A similar 26% reduction in mortality was observed when only the 4 randomized trials were included (95% confidence interval, 11%-40%; P=0.002). These results were not significantly altered after adjustment for baseline characteristics. No significant difference in the risk of syncope was observed with conventional versus therapy reduction programming (P=0.5). Conclusions-Therapy reduction programming results in a large, significant, and consistent reduction in mortality, with no apparent increase in the risk of syncope. (Circ Arrhythm Electrophysiol. 2014;7:164-170.)

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

“…Syncopal episodes related to arrhythmic events and deaths were similar between the 2 groups.Following shortly on the heels of these trials, 2 meta-analyses including the above studies were published in 2014. Tan et al presented the data from the RELE-VANT, PREPARE, MADIT-RIT, ADVANCE III, PROVIDE, and EMPIRIC trials [100,101]. A 30% reduction in the risk of death was found in the therapy reduction group when including all 6 studies; however, similar results were observed when separately considering the 4 randomized trials and the 2 observational studies.…”

Safety and efficacy of high-rate cutoff and long detection interval ICD programming in secondary prevention patients

“…However, shock therapies have been reported to be associated with pain, depression, proarrhythmia, and increased risk of all-cause mortality [4][5][6][7]. Several trials demonstrated that a long detection window and a high-rate cutoff reduced ICD therapies in primary prevention (PP) patients [8][9][10][11][12]. As for secondary prevention (SP) patients, only one subanalysis of the ADVANCE III randomized clinical trial reported that the ICD setting that combined a long detection window for ventricular tachyarrhythmias ≤320 ms with antitachycardia pacing (ATP) during charge reduced overall ICD therapies in SP patients [13].…”

Optimal programming management of ventricular tachycardia storm in ICD patients

“…Optimal programming aiming at reducing inappropriate or unnecessary shocks may provide up to a 30% relative decrease in mortality with no apparent increase in the risk of syncope[31]. During a VTS, ICD programming focuses on minimizing the frequency of shocks.…”