Long Detection Programming in Single-Chamber Defibrillators Reduces Unnecessary Therapies and Mortality

Abstract

Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175).

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

“…For example, although we studied dualchamber pacemaker-defibrillators only (because MADIT-RIT excluded single-chamber [VVI] ICDs), recent data indicate that programming a long detection is associated with a lower risk of therapies, shocks, hospitalization, and death among patients implanted with VVI units also and practice guidelines may be extended to this set of CIEDs. 4 The results of the current debate on merits of extrapolating manufacturerspecific programming sets to generic recommendations may lead to the need for future adjustments. Progress can be tracked and updated by remote monitoring mechanisms.…”

“…We did not adjudicate shocks or atrial fibrillation, nor assess patient outcomes, because the link between these and the tested programming parameter sets were established in prior randomized controlled trials. [2][3][4][5]…”

“…2 The importance of these results, in conjunction with subsequent randomized trials showing similar findings, motivated publication of the 2015 Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society/Sociedad Latinoamericana de Estimulaci on Card ıaca y Electrofisiolog ıa (SOLAECE) Expert Consensus Statement on optimal ICD programming and testing, assigning a class 1A recommendation to optimization of programming, using generic programming sets. [3][4][5] However, the speed and extent to which these publications affect realworld practice is relatively unknown and little investigated. (In comparison, pharmacological therapy among patients with heart failure has been well examined and indicates a gap between evidence and practice, which may persist for years.…”

Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria

“…The VF window was set at 300 ms in secondary prevention and 340 ms in primary prevention with a SVT limit of 260 ms. 15 Furthermore, single-chamber devices were only used in a subgroup of patients in the PREPARE, 16 PROVIDE, 17 and ADVANCE III trials. 12 Only in PROVIDE high rate (VT 181-214 beats/min), long detection times (number of intervals to detect VT = 25), and discriminators were programmed (experimental group). This trial showed in the subgroup of patients with single-chamber devices no statistical difference in the rate of receiving a first shock (primary endpoint) between the conventional group and the experimental group.…”

The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes

“…As with other patients who receive a primary prevention ICD, programming parameters should be optimized to avoid inappropriate shocks through long detection times and high detection rates. [39][40][41] Prospective clinical trials are necessary to better define evidence-based indications for substrate-specific primary prevention ICD use.…”