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. 2020 May 11;1(2):77-82.
doi: 10.1016/j.hroo.2020.04.001. eCollection 2020 Jun.

Implantable cardioverter-defibrillator programming after first occurrence of ventricular tachycardia in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT)

Mehmet K Aktas  1 , Amanda L Bennett  1 , Arwa Younis  1 , Valentina Kutyifa  1 , Bronislava Polonsky  1 , Scott McNitt  1 , Wojciech Zareba  1 , Spencer Rosero  1 , Ilan Goldenberg  1
Affiliations

Implantable cardioverter-defibrillator programming after first occurrence of ventricular tachycardia in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT)

Mehmet K Aktas et al. Heart Rhythm O2. .

Abstract

Background: Implantable cardioverter-defibrillator (ICD) programming to novel settings can reduce the risk of inappropriate therapies.

Objective: The purpose of this study was to evaluate the impact of novel ICD programming after the first occurrence of ventricular tachycardia (VT).

Methods: In MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy) patients who experienced a first occurrence of VT, the risk of subsequent inappropriate and appropriate ICD therapies and adverse cardiovascular events by ICD programming to Arm A (conventional: VT ≥170 bpm), Arm B (high rate: VT ≥200 bpm), or Arm C (duration delay: ≥60-second delay before therapy ≥170 bpm) was determined.

Results: Among 205 patients, ICD programming changes were made in 30 patients (15%) after they experienced a VT episode; 117 patients (57%) were programmed to Arm A settings and 88 patients (43%) to Arm B/C settings. At 15-month follow-up, the cumulative probability of inappropriate ICD therapy was significantly lower in Arm B/C compared to Arm A (9% vs 20%; log-rank P = .029 for overall difference). The rate of appropriate ICD therapy also was significantly lower in Arm B/C compared to Arm A (32% vs 64%; log-rank P = .001 for overall difference). Multivariate analysis showed that patients programmed to Arm B/C after the occurrence of VT had a 71% reduction (P = .02) in the risk of inappropriate ICD therapies and a 43% reduction (P = .02) in the risk of appropriate ICD therapies compared to Arm A.

Conclusion: The benefit of high-rate cutoff or duration delay settings in patients with an ICD is maintained after the first occurrence of VT.

Keywords: Heart failure; Implantable cardioverter-defibrillator programming; Implantable cardioverter-defibrillator shock; Inappropriate implantable cardioverter-defibrillator shock; Ventricular tachycardia.

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Figures

Figure 1
Figure 1
Kaplan-Meier estimates of the cumulative probability of inappropriate implantable cardioverter-defibrillator therapy with 95% pointwise confidence intervals among patients programmed to Arm A compared to Arm B/C.
Figure 2
Figure 2
Kaplan-Meier estimates of the cumulative probability of appropriate implantable cardioverter-defibrillator therapy with 95% pointwise confidence intervals among patients programmed to Arm A compared to Arm B/C.
Figure 3
Figure 3
Kaplan-Meier estimates of the cumulative probability of adverse cardiovascular events with 95% pointwise confidence intervals among patients programmed to Arm A compared to Arm B/C. HF = heart failure.
See this image and copyright information in PMC

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References

    1. Moss A.J., Zareba W., Hall W.J. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–883. - PubMed
    1. Bardy G.H., Lee K.L., Mark D.B. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–237. - PubMed
    1. Moss A.J., Schuger C., Beck C.A. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:2275–2283. - PubMed
    1. Poole J.E., Johnson G.W., Hellkamp A.S. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–1017. - PMC - PubMed
    1. Gasparini M., Proclemer A., Klersy C. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA. 2013;309:1903–1911. - PubMed

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