Effect of Novel Programming on Inappropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Very Low Ejection Fraction (from A MADIT-RIT)
Section snippets
Methods
The protocol and results of the Multicenter Automatic Defibrillator Implantation Trial – Reduce inappropriate Therapy (MADIT-RIT) have been described previously.6
All patients enrolled in MADIT-RIT had dual-chamber ICD or CRT-D devices, thus including atrial discrimination for inappropriate ICD therapy detection. Ventricular tachycardia (VT) and fibrillation detection and therapy programming were according to randomization arm, with the 3 programming arms differing in the heart rate cutoff for
Results
Relevant baseline clinical characteristics of conventional programming, high-rate programming, and delayed therapy programming patients are depicted in Table 1. The study involved 140 patients (9%) with LVEF<15%, 585 patients (39%) with LVEF 15% to 25%, and 774 patients (52%) with LVEF>25%. The average follow-up was 17 ± 7 months (median: 17 months, Q1: 12 months, Q3: 23 months). Average LVEF was 26%. Baseline clinical characteristics, including race, gender, baseline LVEF, defibrillator type,
Discussion
In the present substudy analysis of the MADIT-RIT, we demonstrate that the rates of inappropriate ICD therapies are significantly lower in patients with novel programming than conventional programming for all LVEF ranges. However, there is an exceptional 97% decrease in the risk of inappropriate therapies with high-rate programming in patients with very low LVEF (LVEF <15%). Importantly, there is no increase in mortality or syncopal episodes in patients receiving novel programming in all LVEF
Disclosures
Dr. Dauberthas received honoraria for: events committee, data safety monitoring board, bonsulting, advisory boards and/or for lectures from: Abbott, Acutus Medical, Biosense, Biotronik, Boston Scientific, Farapulse, Medtronic, Microport, Phillips, and Vytronus.
Dr. Goldenberg has received grants from Boston Scientific, Abbott, and Medtronic. Dr. Kutyifa has received research grants from Boston Scientific, ZOLL Inc., Biotronik, Spire, and National Institutes of Health and received consultant fees
References (16)
- et al.
Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality
J Am Coll Cardiol
(2011) - et al.
Clinical variables predicting inappropriate use of implantable cardioverter-defibrillator in patients with coronary heart disease or nonischemic dilated cardiomyopathy
Am J Cardiol
(2005) - et al.
Relation of advanced heart failure symptoms to risk of inappropriate defibrillator shocks
Am J Cardiol
(2006) - et al.
Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: a systematic review and meta-analysis of death and adverse outcomes
Int J Cardiol
(2016) - et al.
Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact
J Am Coll Cardiol
(2008) - et al.
Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: result of the MADIT-RIT efficacy analysis
Heart Rhythm
(2015) - et al.
Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction
N Engl J Med
(2002) - et al.
Heart failure severity, inappropriate ICD therapy, and novel ICD programming: a MADIT-RIT substudy
Pacing Clin Electrophysiol
(2017)
Cited by (0)
The MADIT-CRT study was funded by an unrestricted research grant from Boston Scientific grant XX, to the University of Rochester Medical Center, Rochester, New York.