Title

Reduction in Inappropriate ICD Therapy in MADIT-RIT Patients Without History of Atrial Tachyarrhythmia.

Document Type

Article

Publication Date

8-1-2015

Publication Title

Journal of cardiovascular electrophysiology

Abstract

BACKGROUND: There are limited data whether history of atrial tachyarrhythmia (AT) modifies the risk of inappropriate ICD therapy, or the efficacy of novel ICD programming to reduce inappropriate ICD therapy events.

METHODS: In MADIT-RIT, we investigated the effects of novel ICD programming with high-rate cut-off VT zone ≥ 200 bpm (arm B), or 60-second delayed therapy in the VT zone 170-199 bpm (arm C), compared to conventional programming VT zone>170 bpm (arm A) on first inappropriate ICD therapy in those with or those without AT prior to enrollment.

RESULTS: In patients with prior AT (n = 203, 14%) there was a higher risk of inappropriate ICD therapy (HR = 2.10, 95% CI: 1.38-3.20, P < 0.001), and inappropriate ICD shock (HR = 2.56, 95% CI: 1.38-4.74, P = 0.003) compared to those with no prior AT. The effects of innovative programming to reduce inappropriate ICD therapy with either high-rate cut-off or delayed VT therapy were similar in patients with prior AT (arm B vs. A HR = 0.11, P < 0.001, arm C vs. A HR = 0.17, P < 0.001), and also in patients without prior AT before enrollment (arm B vs. A HR = 0.15, P < 0.001, arm C vs. A HR = 0.24, P < 0.001, interaction P-values >0.10 for all).

CONCLUSIONS: Novel ICD programming with a high-rate cut-off or delayed therapy is equally beneficial to reduce inappropriate ICD therapy in patients with or without prior AT, despite the lower risk of inappropriate ICD therapy in patients without prior AT.

Medical Subject Headings

Aged; Atrial Fibrillation; Atrial Flutter; Canada; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Europe; Female; Heart Rate; Humans; Israel; Japan; Male; Middle Aged; Primary Prevention; Prosthesis Design; Prosthesis Failure; Risk Factors; Tachycardia, Ventricular; Time Factors; Treatment Outcome; United States

PubMed ID

25917337

Volume

26

Issue

8

First Page

879

Last Page

884

Share

COinS