Not So Fast! Programming ICDs to Reduce Unnecessary Therapy

Longer detection times for ICD-documented arrhythmias reduce ATP and inappropriate shocks without reducing appropriate therapy.

In MADIT-RIT, programming implantable cardioverter-defibrillators (ICDs) not to treat slower ventricular tachyarrhythmia (VT) and to allow longer time periods for self-termination not only reduced antitachycardia pacing (ATP) and shocks, but also improved mortality, compared with out-of-the-box programming (JW Cardiol Nov 6 2012). However, MADIT-RIT included only primary-prevention patients without atrial fibrillation (AF) and with dual-chamber or biventricular devices.

By contrast, the manufacturer-sponsored ADVANCE III trial included primary- and secondary-prevention patients with or without AF and with single-chamber, dual-chamber, or biventricular devices. A total of 1902 patients were randomized to programmed VT detection of either 18 o…

Reviewing Author

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate