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Optimizing ICD programming for shock reduction
Author(s) -
Schwab Joerg O.
Publication year - 2010
Publication title -
fundamental and clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.655
H-Index - 73
eISSN - 1472-8206
pISSN - 0767-3981
DOI - 10.1111/j.1472-8206.2010.00868.x
Subject(s) - medicine , implantable cardioverter defibrillator , randomized controlled trial , ventricular fibrillation , defibrillation , atrial fibrillation , anxiety , prospective cohort study , cardiology , shock (circulatory) , cohort , depression (economics) , clinical trial , psychiatry , economics , macroeconomics
With the increasing numbers of patients with implantable cardioverter/defibrillators for primary prevention (PP), the topic of inappropriate therapy becomes more and more important. If a shock intervention, e.g. for rapidly conducted atrial fibrillation or fast VT (FVT), represents the first reminder of the implantable cardioverter/defibrillator (ICD), the adherence to the therapy will decrease. Moreover, anxiety to receive the next inappropriate ICD Rx is able to initiate a bad quality of life or depression. Starting with the PainFREE Rx II Trial results, the programming of antitachycardia pacing was able to terminate even fast ventricular arrhythmia, i.e. ≥188 bpm, in three of four episodes. Thereafter, several studies evaluated whether a prolongation in ventricular tachyarrhythmia (VT) detection is able to reduce unnecessary ICD Rx owing to nonsustained VT. The PREPARE trial evaluated this concept in a cohort of PP patients. This nonrandomized study compared a historical control group to patients with a prolonged detection interval. The results underline the idea that an extension in detection time leads to a significant decrease in ICD Rx for supra‐ as well as VT. The RELEVANT study investigated in a randomized fashion the outcome of an increase in detection time in nonischemic patients under CRT including an ICD. The findings clearly demonstrated a reduction in ICD Rx as well as hospital admissions, significantly. Currently, the ADVANCE III trial investigates a 30/40 interval detection compared to 18/24 for FVT in prospective randomized fashion in patients for primary or secondary prevention including all ICD devices.