4 updates on ICDs in 2015

Implantable cardioverter defibrillators are an important technology for preventing sudden death among patients with various cardiac arrhythmias.

While further advances in this area of treatment are on the horizon, 2015 has already yielded interesting data with regard to ICD use in clinical practice and remote monitoring for ICDs and other devices, emerging technology that would allow for full-body MRI among patients with an ICD and novel programming algorithms that may reduce administration of unnecessary shocks.

The following are four ICD-related updates that have emerged in 2015.

1. ICDs are underutilized in elderly patients after MI.

Results from a registry study of 10,318 patients with MI and reduced ejection fraction indicated that fewer than one in 10 older adults who were eligible for an ICD received one, despite a significantly reduced risk for mortality observed at 2 years among patients who did.

Patients were less likely to receive an ICD following MI if they were of advanced age, female and had end-stage renal disease. However, the researchers noted that the reduced mortality risk associated with ICD use was present regardless of age or sex. Read more

2. Remote monitoring of ICDs and similar devices can reduce hospitalizations, costs.

Jonathan P. Piccini

According to a study presented at the Heart Rhythm Society Annual Scientific Sessions, remote monitoring of ICDs, pacemakers and cardiac resynchronization therapy devices was associated with lower all-cause hospitalization costs per patient year, shorter hospital length of stay and fewer hospitalizations per year.

While these benefits were observed for all evaluated devices, the magnitude of benefit from remote monitoring was greatest in ICDs and CRT-defibrillators, Jonathan P. Piccini, MD, MHSc, FACC, FAHA, FHRS, and colleagues reported. Read more

3. A new ICD system compatible with full-body MRI was found safe and effective in the Evera MRI study.

Michael R. Gold

In a study of 275 patients presented at the HRS Annual Scientific Sessions, researchers reported that Evera MRI (Medtronic), was safe and effective in patients undergoing MRI at 1.5 T.

Patients were randomly assigned to either Evera MRI, an ICD device developed to be compatible with full-body MRI, or a 1-hour waiting period without MRI. Michael R. Gold, MD, PhD, FHRS, and colleagues observed no significant difference between the MRI group and controls with regard to ventricular pacing capture threshold or R-wave amplitude.

No patients who underwent MRI experienced a composite safety endpoint including MRI-related complications 30 days after the scan and sustained tachyarrhythmia during MRI. Read more

4. A new algorithm may be effective for reducing unnecessary ICD shocks.

Angelo Auricchio

Results from the PainFree SST study indicated that a novel discrimination algorithm formulated to differentiate between true ventricular arrhythmias and other rhythms yielded a low rate of inappropriate shocks among patients with single- and dual/triple chamber ICDs.

In addition to the low inappropriate shock rate, no deaths over the course of the study were associated with inappropriate therapy or inappropriately withheld therapy with the device, according to Angelo Auricchio, MD, PhD, FESC, and colleagues. Read more