Open AccessEvaluation of defibrillation safety and shock reduction in implantable cardioverter‐defibrillator patients with increased time to detection: A randomized SANKS study
Author(s) -
Noro Mahito,
Zhu Xin,
Takagi Takahito,
Sahara Naohiko,
Narabayashi Yuriko,
Hashimoto Hikari,
Ito Naoshi,
Enomoto Yoshinari,
Kujime Shingo,
Sakai Tuyoshi,
Sakata Takao,
Matushita Noriko,
Fukamizu Seiji,
Okano Yoshifumi,
Anami Yoshiaki,
Tejima Tomoyuki,
Kuroiwa Kouji,
Ikeda Takanori,
Sakurada Harumizu,
Sugi Kaoru
Publication year - 2015
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2014.08.003
Subject(s) - medicine , defibrillation , implantable cardioverter defibrillator , cardiology , defibrillation threshold , shock (circulatory) , randomized controlled trial , cardiac resynchronization therapy , adverse effect , heart failure , ejection fraction
1 Background The need for ways to minimize the number of implantable cardioverter‐defibrillator (ICD) shocks is increasing owing to the risk of its adverse effects on life expectancy. Studies have shown that a longer detection time for ventricular tachyarrhythmia reduces the safety of therapies, in terms of syncope and mortality, but not substantially in terms of the success rate. We aimed to evaluate the effects of increased number of intervals to detect (NID) VF on the safety of ICD shock therapy and on the reduction of inappropriate shocks. Methods The present study was a prospective, multicenter, randomized, crossover study. Randomized VF induction testing with NID 18/24 or 30/40 was performed to compare the success rate of defibrillation with a 25‐J shock and the time to detection. Inappropriate shock episodes were simulated retrospectively to evaluate a possibility of episodes avoidable at NID 24/32 and 30/40. Results Thirty‐one consecutive patients implanted with an ICD or cardiac resynchronization therapy‐defibrillator (CRT‐D) were enrolled in this study. The success rate of defibrillation was 100% in both NID groups at the first shock. The time from VF induction to detection showed a significant increase in the NID 30/40 group (6.16±1.29 s vs. 9.00±1.31 s, p <0.001). Among the 120 patients implanted with an ICD or CRT‐D, 10 experienced 32 inappropriate shock episodes. The inappropriate shock reduction rate was 53.1% and 62.5% with NID 24/32 and 30/40, respectively. Conclusions The findings of this SANKS study suggest that VF NID 30/40 does not compromise the safety of ICD shock therapy, while decreasing the number of inappropriate shocks.