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Strategic programming can reduce unnecessary ICD shocks

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Heart Rhythm Society 31st Annual Scientific Sessions

DENVER — The application of several different programming strategies for implantable cardioverter defibrillators can significantly reduce unnecessary shocks, results from a large observational study indicated.

Researchers evaluated an observational cohort of 88,804 patients with either a cardiac resynchronization device or a dual-chamber ICD. The researchers then entered four shock-reduction programming strategies and clinical characteristics into a multivariable model. The strategies were as follows: including the slowest ventricular tachycardia/ventricular fibrillation (VT/VF) detection threshold; adjusting the number of intervals needed to detect ventricular fibrillation; using supraventricular tachycardia discriminators; and employing anti-tachycardia pacing (ATP). The primary study endpoint was the number of spontaneous all-cause shocked episodes per 100 patient-years.

There were 72,239 shocked episodes among 19,458 patients (22%). After adjusting for all variables, the researchers reported that lengthening the intervals needed to detect VF (from 12/16 to 24/32 or 32/40) reduced shocks by 17%; using supraventricular tachycardia discriminators reduced shocks by 22%; and utilizing ATP reduced shocks by 28%. Patients with devices programmed to a slower detection threshold (148%) or those who had prior atrial fibrillation with rapid ventricular tachycardia (244%) had an increased risk for shocks. Female sex and having a cardiac resynchronization device were associated with fewer shocks.

“Physicians should use strategic programming, including increasing the VT/VF detection thresholds prolonging tachycardia protection;; turning on supraventricular tachycardia discriminators; and using ATP for fast VTs,” Bruce L. Wilkoff, MD, director of cardiac pacing and tachyarrhythmia devices at the Cleveland Clinic, said in a presentation. “The clinical actions to decrease morbidity from shocks should include early identification of AF with rapid ventricular response to ensure adequate rate control for the AF.”

The study was conducted with support from Medtronic. – by Eric Raible

For more information:

• Wilkoff BL. LBCT I. Presented at: Heart Rhythm Society 31st Annual Scientific Sessions; May 12-15, 2010; Denver.

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