Curr Cardiol Rep (2014) 16:496 DOI 10.1007/s11886-014-0496-1
INVASIVE ELECTROPHYSIOLOGY AND PACING (EK HEIST, SECTION EDITOR)
ICD Programming to Reduce Shocks and Improve Outcomes Valentina Kutyifa & Wojciech Zareba & Arthur J. Moss
Published online: 13 May 2014 # Springer Science+Business Media New York 2014
Abstract Despite the clinical benefit of implantable cardioverter defibrillator (ICD), there is a high frequency of inappropriate ICD therapy associated with impaired quality of life, unwanted health care resource utilization, and adverse clinical outcome. Alternative strategies of ICD programming are needed to reduce the risk of inappropriate and “unnecessary” ICD therapies and to improve patient outcome. In this review, we provide an overview of the rate of inappropriate and appropriate ICD therapies in clinical trials and large registries as well as a review of current trials evaluating novel ICD programming to reduce inappropriate ICD therapy to avoid unnecessary ICD therapy. Based on recent studies including a large randomized trial, we recommend a simple programming approach involving high-rate device therapy beginning at 200 bpm with a 2.5 sec delay for it reduces inappropriate therapy, unnecessary therapy, and all-cause mortality in patients receiving ICD or CRT-D devices for primary prevention indications.
Keywords Implantable cardioverter defibrillator . ICD programming . Inappropriate therapy . Appropriate therapy . ICD shock . Outcome This article is part of the Topical Collection on Invasive Electrophysiology and Pacing V. Kutyifa : W. Zareba : A. J. Moss Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
Introduction The implantable cardioverter defibrillator (ICD) delivers rapid pacing stimuli (anti-tachycardia pacing [ATP]) or an ICD shock to terminate ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients at high-risk for life-threatening ventricular tachyarrhythmias. Several randomized trials and registries have shown improved survival in patients with impaired left ventricular function and mild to moderate heart failure who were treated with ICDs [1–4]. The number of ICD implantations in the United States is increasing [5]. From January 1, 2006 until December 31, 2009, there were over 486,000 ICD’s implanted according to the National Cardiovascular Data Registry ICD registry [6]. However, patients with an implanted ICD are at an increased risk of inappropriate ICD therapies (for other than life-threatening arrhythmias), and these inappropriate therapies are associated with psychological consequences [7], impaired quality of life [8], and most importantly, with adverse clinical outcome [9–11]. In addition, a proportion of ICD therapies delivered for ventricular tachyarrhythmias may not be necessary if the episode were to terminate spontaneously, and these device discharges are the so-called unnecessary ICD therapies. In this review, we will provide an overview of inappropriate and appropriate ICD therapy rates in clinical trials and registries, and we will review the current data on studies to reduce inappropriate or unnecessary ICD therapy in patients with primary and secondary indications for preventive ICD therapy.
W. Zareba e-mail:
[email protected] A. J. Moss e-mail:
[email protected] V. Kutyifa (*) Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY 14642, USA e-mail:
[email protected]
The Incidence of Inappropriate and Appropriate ICD Therapy and Clinical Outcome Major ICD clinical trials and large registry data on the rate of inappropriate and appropriate ICD therapy are listed in Table 1. The AVID clinical trial [12] evaluated 449 patients
Single Single/dual Single/dual Single/dual 5.68 (3.97 – 8.12) p
