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Reduction in Inappropriate ICD Therapy in MADIT‐RIT Patients Without History of Atrial Tachyarrhythmia
Author(s) -
KUTYIFA VALENTINA,
MOSS ARTHUR J.,
SCHUGER CLAUDIO,
MCNITT SCOTT,
POLONSKY BRONISLAVA,
RUWALD ANNECHRISTINE H.,
RUWALD MARTIN H.,
DAUBERT JAMES P.,
ZAREBA WOJCIECH
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12692
Subject(s) - medicine , cardiology , implantable cardioverter defibrillator , shock (circulatory) , cardiac resynchronization therapy , heart failure , ejection fraction
Atrial Arrhythmia History in MADIT‐RIT 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.