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Clinical Articles, News & Views

New ICD programme to reduce inappropriate shocks

New programming criteria for implantable cardioverter defibrillator (ICD) devices could cut the risk of inappropriately delivered therapy by almost 80%, according to results1 from the MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy, sponsored by Boston Scientific) published recently in the New England Journal of Medicine.

Researchers led by Dr Arthur J Moss (University of Rochester, New York) randomly assigned 1,500 patients with a primary-prevention indication to receive an ICD with one of three programming configurations.

The primary objective was to determine whether programmed high-rate therapy (with a 2.5-second delay before the initiation of therapy at a heart rate of ≥200 beats per minute) or delayed therapy (with a 60-second delay at 170 to 199 beats per minute, a 12-second delay at 200 to 249 beats per minute, and a 2.5-second delay at ≥250 beats per minute) was associated with a decrease in the number of patients with a first occurrence of inappropriate antitachycardia pacing or shocks, as compared with conventional programming (with a 2.5-second delay at 170 to 199 beats per minute and a 1.0-second delay at ≥200 beats per minute).

During an average follow-up of 1.4 years, high-rate therapy and delayed ICD therapy, as compared with conventional device programming, were associated with reductions in a first occurrence of inappropriate therapy (hazard ratio with high-rate therapy vs. conventional therapy, p<0.001; hazard ratio with delayed therapy vs. conventional therapy, p<0.001) and reductions in all-cause mortality (hazard ratio with highrate therapy vs. conventional therapy, p=0.01; hazard ratio with delayed therapy vs. conventional therapy, p=0.06). There were no significant differences in procedure-related adverse events among the three treatment groups.

References

1. Moss AJ, Schuger C, Beck CA, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012. http://dx.doi.org/10.1056/NEJMoa1211107

Published on: November 15, 2012

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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