Programming ICDs in the Modern Era beyond Out‐of‐the Box Settings

Abstract

Implantable cardioverter-defibrillators (ICDs) improve survival when used as primary or secondary prevention therapy in patients with a broad spectrum of disorders associated with a high risk of sudden death. As indications continue to be refined, attention has increasingly turned to ICD-related complications and their impact on quality of life. Foremost among these complications are inappropriate shocks. This issue remains a major challenge, despite technological advances with sophisticated recording capabilities and detection algorithms. While pharmacological and catheter-based interventions represent important adjunctive tools for the reduction of inappropriate shocks, this contemporary review focuses on customizing and optimizing ICD programming. Studies addressing ICD programming beyond "out the box" settings are reviewed for each device manufacturer and special circumstances are considered. We discuss the benefits and pitfalls of strategies such as high cutoff rates, longer detections times, antitachycardia pacing, and discriminators in reducing the incidence of inappropriate shocks and offer practical programming tips.

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

“…We summarize the most commonly used discriminators. More comprehensive discussions are available in the literature [107][108][109][110][111].…”

Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand

“…Therefore, programming of rate-smoothing for all does not appear justified; when it is programmed (e.g. for LQTS), a value ≥12% is recommended [72]. Cardiac pacing may reduce the risk of VT in some LQTS patients [105].…”

ICD Follow‐Up and Troubleshooting

“…In the presence of high cut-off rates, the monitoring zone may be of value to assess the need for multizone programming. 22 delays that disrupt left-sided AV timing (AV desynchronization). While one may question the impact of monitoring zones on battery longevity, company technicians report negligible effects.…”