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. 2021 Dec;44(12):1995-2004.
doi: 10.1111/pace.14386. Epub 2021 Nov 2.

Generic ICD programming and outcomes

Parisha Khan  1 , Nishat Jahagirdar  1 , Micaela Laybourn  1 , Idris Harding  1 , Antonio Cannatà  1   2 , Daniel I Bromage  1   2 , Husain Shabeeh  1 , Peter Kabunga  1 , Edward Petzer  1 , Francis Murgatroyd  1 , Paul A Scott  1
Affiliations

Generic ICD programming and outcomes

Parisha Khan et al. Pacing Clin Electrophysiol. 2021 Dec.

Abstract

Introduction: Generic ICD programming, where shock-reduction programming is extrapolated from trials of one manufacturer to another, may reduce non-essential ICD therapies beyond that seen in randomized trials. However, the benefits and risks are unknown. The purpose of this retrospective cohort study was to evaluate the impact of a standardized programming protocol, based on generic programming, across manufacturers.

Methods: We included all new ICDs in a single center (2009-2019). In 2013 a standardized programming protocol based on generic programming was introduced, incorporating high detection rates (200 bpm for primary prevention) and long detection (30/40 or equivalent in VF zone) for all patients. Patients were classified into three groups based on implant programming: pre-guideline (PS), post-guideline and guideline compliant (GC) and post-guideline but not guideline compliant (NGC). The end-points were the first occurrence of any device therapy (ATP or shock), ICD shock, syncope and all-cause mortality. Survival analysis was used to evaluate outcomes.

Results: 1003 patients were included (mean follow-up 1519 ± 1005 days). In primary prevention patients (n = 583) freedom from ICD therapy (91.5% vs. 73.6%, p < .001) or shock (94.7% vs 84.8%, p = .02) were significantly higher in GC compared to PS patients, without significant increase in syncope or mortality. In secondary prevention patients (n = 420) freedom from any ICD therapy or any shock were non-significantly higher in GC compared to PS patients, without an increase in syncope or mortality.

Conclusions: In primary prevention patients a standardized programming protocol, incorporating generic programming, reduced the burden of ICD therapy without an increase in adverse outcomes.

Keywords: antitachycardia pacing; implantable cardioverter-defibrillator; programming; shocks tachycardiac detection; ventricular tachycardia.

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References

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