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ADVANCE III: Longer detection window effective in reducing unnecessary ICD therapy

Issue: July 2012

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BOSTON — An extended detection window of 30/40 intervals to detect arrhythmias safely and successfully decreased the number of inappropriate shocks in patients with implantable cardioverter defibrillators, according to results from the ADVANCE III trial presented at the Heart Rhythm Society’s 33rd Annual Scientific Sessions.

Maurizio Gasparini, MD, of IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy, and colleagues conducted a prospective, parallel, randomized, single blind study of 1,903 primary and secondary prevention patients. All were implanted with a Medtronic device from 2008 to 2010.

The researchers randomly assigned 948 patients to 30/40 intervals and 954 to 18/24 intervals for a median follow-up of 12 months. The patients’ mean age was 65 years and 84% were men. Approximately 39% of patients had single-chamber devices; 31% dual-chamber devices; and 41% cardiac resynchronization therapy devices.

Study results showed a 37% reduction in unnecessary ICD therapy, with 346 therapies occurring in the 30/40-interval arm and 557 in the 18/24-interval arm (95% CI, 22-49). Kaplan-Meier estimates also revealed a significant difference in patient probability of therapy occurrence.

Gasparini said there was no statistically significant difference syncope events associated with episodes of ventricular arrhythmia between patients in the 30/40 vs. 18/24 groups (2.2 patients per year vs. 1.1 patients per year; P=.21). In addition, mortality was low in both study arms (3.9 patients per year vs. 4.6 patients per year, respectively).

“ADVANCE III is the first randomized trial enrolling primary and secondary prevention patients, both ischemic and nonischemic, to assess efficacy and safety of long NID detection in any ICD with anti-tachycardia pacing during charging,” Gasparini said. “The longer NID 30/40 detection window was safe and effective in reducing unnecessary ICD therapies, with no significant difference in syncope events.”

Disclosure: Dr. Gasparini reports no relevant financial disclosures.