Defensive Implantable Cardioverter-Defibrillator Programming Is Safe and Reduces Inappropriate Therapy　― Comparison of 3 Programming Strategies in 1,471 Patients ―

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  • Burger Achim Leo
    Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna
  • Stojkovic Stefan
    Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna
  • Schmidinger Herwig
    Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna
  • Ristl Robin
    Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna
  • Pezawas Thomas
    Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna

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<p>Background: Careful device programming is necessary to reduce inappropriate antitachycardia pacing (ATP) and shock therapy in recipients of implantable cardioverter-defibrillators (ICD). This retrospective study investigated the safety and efficacy of a therapy-reducing programming strategy in comparison with conventional strategies in consecutive ICD recipients of a university cardiac center. </p><p>Methods and Results: All 1,471 ICD recipients from 2000 to 2015 were analyzed. Individual ICD programming (IND) was used from 2000 to 2005 followed by standard-three-zone programming (STD) until 2010. From 2010 to 2015 therapy-reducing long detection time programming (RED) was established. The mean follow-up was 2.4±1.6, 2.3±1.6 and 1.7±1.2 years in the IND, STD and RED groups, respectively. Switchover from IND to STD revealed a significant reduction in inappropriate ATP (P=0.024) and shock therapy (P<0.001). Further reduction of 58% (RR=0.42, 95% confidence interval [CI]: 0.17–1.04; P=0.061) in inappropriate ATP and 29% (RR=0.71, 95% CI: 0.29–1.72; P=0.452) in inappropriate shock therapy was achieved by switchover from STD to RED. Kaplan-Meier analysis revealed a significant difference in time until first inappropriate ATP and shock therapy among the 3 groups, being lowest in the RED group (P≤0.001). There was no difference in overall mortality (P=0.416). </p><p>Conclusions: Defensive ICD programming with prolonged detection times is safe and significantly reduced inappropriate ICD therapies. </p>

収録刊行物

  • Circulation Journal

    Circulation Journal 82 (12), 2976-2982, 2018-11-24

    一般社団法人 日本循環器学会

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