Relation between detection rate and inappropriate shocks in single versus dual chamber cardioverter-defibrillator – an analysis from the OPTION trial

Abstract

The programming of implantable cardioverter-defibrillators (ICDs) influences inappropriate shock rates. The aim of the study is to analyse rates of patients with appropriate and inappropriate shocks according to detection zones in the OPTION trial. All patients received dual chamber (DC) ICDs randomly assigned to be programmed either to single chamber (SC) or to DC settings including PARAD+ algorithm. In a post-hoc analysis, rates of patients with inappropriate and appropriate shocks were calculated for shocks triggered at heart rates ≥170 bpm (ventricular tachycardia zone) and at rates ≥200 bpm (ventricular fibrillation zone). In the SC group, higher rates of patients with total and inappropriate shocks were delivered at heart rates ≥170 bpm than at rates ≥200 bpm (total shocks: 21.1% vs. 16.6%; p = 0.002; inappropriate shocks: 7.6% vs. 4.5%, p = 0.016; appropriate shocks: 15.2% vs. 13.5%; p = n.s.). No such differences were observed in the DC group (total shocks: 14.3% vs. 12.6%; p = n.s.; inappropriate shocks: 3.9% vs. 3.6%; p = n.s.; appropriate shocks: 12.2% vs. 10.4%; p = n.s.). The higher frequency of patients with total shocks with SC settings than with DC settings that benefit from PARAD+ was driven by a higher percentage of patients with inappropriate shocks in the VT zone (170–200 bpm) in the SC population.

A propensity matched case–control study comparing efficacy, safety and costs of the subcutaneous vs. transvenous implantable cardioverter defibrillator

“…However, in our cohort there was no significant difference in inappropriate shock rates in those with single or two-therapy zones programmed (p=1.00). The inappropriate shock rates in those with single treatment zone programming were similar to that of already published data (27,28). When excluding, from the TV-ICD group those with inappropriate shocks and two-therapy zone programming, the device-related complications were still significantly higher in the TV-ICD group compared to the S-ICD group (p=0.021).…”

“…In all cases of inappropriate shocks we were able to prevent any further recurrence through altering the sensing vector. It has been shown that patients with TV-ICDs with two therapy zones programmed experience higher rates of inappropriate shocks (26)(27)(28). However, in our cohort there was no significant difference in inappropriate shock rates in those with single or two-therapy zones programmed (p=1.00).…”

Low rates of inappropriate shocks in contemporary real-world implantable cardioverter defibrillator patients: the CARAT observational study

“…As the PARAD+® algorithm had been used as default tachyarrhythmia detection algorithm in the presence of a functional atrial lead, CARAT confirms results of previous studies such as OPTION 3 , 4 or ISIS-ICD 5 in terms of arrhythmia discrimination in dual-chamber devices. The present study also reports low inappropriate shocks in single-chamber devices, where arrhythmia discrimination is based on a combination of stability, acceleration, and ‘long cycle gap’ to identify atrial fibrillation.…”

Implantable Cardioverter-Defibrillator for Primary Prevention in Asia

“…Most of the randomized controlled trials and the pooled meta-analyses failed to show any superiority of dual-chamber ICD over single-chamber ICD for primary prevention. 101 , 102 , 103 , 104 The rates of inappropriate shock, hospitalization, or survival were similar. Therefore, a single-chamber ICD should be generally preferred over dual-chamber ICDs unless pacing is needed.…”