Standardized programming to reduce the burden of inappropriate therapies in implantable cardioverter defibrillators - Single centre follow up results

U Boles, E E Gul, L Fitzgerald, F Sadiq Ali, C Nolan, K Aldworth-Gaumond, D R Redfearn, A Baranchuk, B Glover, C Simpson, H Abdollah, K A Michael, U Boles, E E Gul, L Fitzgerald, F Sadiq Ali, C Nolan, K Aldworth-Gaumond, D R Redfearn, A Baranchuk, B Glover, C Simpson, H Abdollah, K A Michael

Abstract

Background: Current algorithms and device morphology templates have been proposed in current Implantable Cardioverter-Defibrillators (ICDs) to minimize inappropriate therapies (ITS), but this has not been completely successful.

Aim: Assess the impact of a deliberate strategy of using an atrial lead implant with standardized parameters; based on all current ICD discriminators and technologies, on the burden of ITS.

Method: A retrospective single-centre analysis of 250 patients with either dual chamber (DR) ICDs or biventricular ICDs (CRTDs) over a (41.9 ± 27.3) month period was performed. The incidence of ITS on all ICD and CRTD patients was chronicled after the implementation of standardized programming.

Results: 39 events of anti-tachycardial pacing (ATP) and/or shocks were identified in 20 patients (8% incidence rate among patients). The total number of individual therapies was 120, of which 34% were inappropriate ATP, and 36% were inappropriate shocks. 11 patients of the 250 patients received ITS (4.4%). Of the 20 patients, four had ICDs for primary prevention and 16 for a secondary prevention. All the episodes in the primary indication group were inappropriate, while seven patients (43%) of the secondary indication group experienced inappropriate therapies.

Conclusions: The burden of ITS in the population of patients receiving ICDs was 4.4% in the presence of atrial leads. The proposed rationalized programming criteria seems an effective strategy to minimize the burden of inappropriate therapies and will require further validation.

Keywords: Implantable cardioverter-defibrillator (ICDs); Inappropriate therapies; Standardized programming.

Copyright © 2017 Indian Heart Rhythm Society. All rights reserved.

Figures

Fig. 1
Fig. 1
This depicts study population and device therapy delivered over the follow up period in the whole study population. The proportion of appropriate and inappropriate therapies and distribution of ITS according to the cause of the underlying cardiomyopathy.
Fig. 2
Fig. 2
Analysis of delivered therapies and SVT episodes eliciting inappropriate therapies. VT = ventricular tachycardia zone, FVT = Fast ventricular tachycardia zone.

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Source: PubMed

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