ICD Programming to Reduce Shocks and Improve Outcomes

  • Valentina Kutyifa
  • Wojciech Zareba
  • Arthur J. Moss
Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing

Abstract

Despite the clinical benefit of implantable cardioverter defibrillator (ICD), there is a high frequency of inappropriate ICD therapy associated with impaired quality of life, unwanted health care resource utilization, and adverse clinical outcome. Alternative strategies of ICD programming are needed to reduce the risk of inappropriate and “unnecessary” ICD therapies and to improve patient outcome. In this review, we provide an overview of the rate of inappropriate and appropriate ICD therapies in clinical trials and large registries as well as a review of current trials evaluating novel ICD programming to reduce inappropriate ICD therapy to avoid unnecessary ICD therapy. Based on recent studies including a large randomized trial, we recommend a simple programming approach involving high-rate device therapy beginning at 200 bpm with a 2.5 sec delay for it reduces inappropriate therapy, unnecessary therapy, and all-cause mortality in patients receiving ICD or CRT-D devices for primary prevention indications.

Keywords

Implantable cardioverter defibrillator ICD programming Inappropriate therapy Appropriate therapy ICD shock Outcome 

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators. N Engl J Med. 1996;335:1933–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83.PubMedCrossRefGoogle Scholar
  3. 3.
    Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Al-Khatib SM, Hellkamp A, Bardy GH, Hammill S, Hall WJ, Mark DB, et al. Survival of patients receiving a primary prevention implantable cardioverter-defibrillator in clinical practice vs clinical trials. JAMA. 2013;309:55–62.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Brown DW, Croft JB, Greenlund KJ, Mensah GA, Giles WH. Trends in hospitalization for the implantation of cardioverter-defibrillators in the united states, 1990-2005. Am J Cardiol. 2008;101:1753–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Hammill SC, Kremers MS, Stevenson LW, Heidenreich PA, Lang CM, Curtis JP, et al. Review of the registry's fourth year, incorporating lead data and pediatric icd procedures, and use as a national performance measure. Heart Rhythm Off J Heart Rhythm Soc. 2010;7:1340–5.CrossRefGoogle Scholar
  7. 7.
    Opic P, Utens EM, Moons P, Theuns DA, van Dijk AP, Hoendermis ES, et al. Psychosocial impact of implantable cardioverter defibrillators (icd) in young adults with tetralogy of fallot. Clin Res Cardiol Off J Ger Card Soc. 2012;101:509–19.CrossRefGoogle Scholar
  8. 8.
    Sweeney MO, Wathen MS, Volosin K, Abdalla I, DeGroot PJ, Otterness MF, et al. Appropriate and inappropriate ventricular therapies, quality of life, and mortality among primary and secondary prevention implantable cardioverter defibrillator patients: results from the pacing fast vt reduces shock therapies (painfree rx ii) trial. Circulation. 2005;111:2898–905.PubMedCrossRefGoogle Scholar
  9. 9.
    Daubert JP, Zareba W, Cannom DS, McNitt S, Rosero SZ, Wang P, et al. Inappropriate implantable cardioverter-defibrillator shocks in madit ii: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51:1357–65.PubMedCrossRefGoogle Scholar
  10. 10.
    van Rees JB, Borleffs CJ, de Bie MK, Stijnen T, van Erven L, Bax JJ, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57:556–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Klein RC, Raitt MH, Wilkoff BL, Beckman KJ, Coromilas J, Wyse DG, et al. Analysis of implantable cardioverter defibrillator therapy in the antiarrhythmics versus implantable defibrillators (avid) trial. J Cardiovasc Electrophysiol. 2003;14:940–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the miracle icd trial. JAMA. 2003;289:2685–94.PubMedCrossRefGoogle Scholar
  14. 14.
    Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, et al. Long-term outcome after icd and crt implantation and influence of remote device follow-up: the altitude survival study. Circulation. 2010;122:2359–67.PubMedCrossRefGoogle Scholar
  15. 15.
    Dorian P. Counterpoint: implantable cardioverter-defibrillator shocks for ventricular tachyarrhythmias increase mortality. Heart Rhythm. 2012;9:1158.PubMedCrossRefGoogle Scholar
  16. 16.
    Gasparini M, Nisam S. Implantable cardioverter defibrillator harm? Europace. 2012;14:1087–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Sweeney MO. Point: implantable cardioverter-defibrillator shocks for ventricular tachyarrhythmias increase mortality. Heart Rhythm. 2012;9:985–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm. 2010;7:353–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Pacifico A, Ferlic LL, Cedillo-Salazar FR, Nasir Jr N, Doyle TK, Henry PD. Shocks as predictors of survival in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol. 1999;34:204–10.PubMedCrossRefGoogle Scholar
  20. 20.
    Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110:3760–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Vollmann D, Luthje L, Vonhof S, Unterberg C. Inappropriate therapy and fatal proarrhythmia by an implantable cardioverter-defibrillator. Heart Rhythm Off J Heart Rhythm Soc. 2005;2:307–9.CrossRefGoogle Scholar
  22. 22.
    Lehto M, Snapinn S, Dickstein K, Swedberg K, Nieminen MS. Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the optimaal experience. Eur Heart J. 2005;26:350–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Pedersen OD, Abildstrom SZ, Ottesen MM, Rask-Madsen C, Bagger H, Kober L, et al. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. Eur Heart J. 2006;27:290–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA, et al. Atrial fibrillation and death after myocardial infarction: a community study. Circulation. 2011;123:2094–100.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Yabe S, Smith WM, Daubert J, Wolf PD, Rollins DL, Ideker RE. Conduction disturbances caused by high current density electric fields. Circ Res. 1990;66:1190–203.PubMedCrossRefGoogle Scholar
  26. 26.
    Hurst T, Hinrichs M, Breidenbach C, Katz N, Waldecker B. Detection of myocardial injury during transvenous implantation of automatic cardioverter-defibrillators. J Am Coll Cardiol. 1999;34:402–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Epstein AE, Kay GN, Plumb VJ, Dailey SM, Anderson PG. Gross and microscopic pathological changes associated with nonthoracotomy implantable defibrillator leads. Circulation. 1998;98:1517–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Geuze RH, de Vente J. Arrhythmias and left ventricular function after defibrillation during acute myocardial infarction in the intact dog. Am Heart J. 1983;106:292–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the prepare (primary prevention parameters evaluation) study. J Am Coll Cardiol. 2008;52:541–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Shome S, Li D, Thompson J, McCabe A. Improving contemporary algorithms for implantable cardioverter-defibrillator function. J Electrocardiol. 2010;43:503–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, et al. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: pacing fast ventricular tachycardia reduces shock therapies (painfree rx ii) trial results. Circulation. 2004;110:2591–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Wathen MS, Sweeney MO, DeGroot PJ, Stark AJ, Koehler JL, Chisner MB, et al. Shock reduction using antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with coronary artery disease. Circulation. 2001;104:796–801.PubMedCrossRefGoogle Scholar
  33. 33.
    Wilkoff BL, Ousdigian KT, Sterns LD, Wang ZJ, Wilson RD, Morgan JM. A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter empiric trial. J Am Coll Cardiol. 2006;48:330–9.PubMedCrossRefGoogle Scholar
  34. 34.••
    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through icd programming. N Engl J Med. 2012;367:2275–83. This study provides evidence on the beneficial effects of novel ICD programming to reduce inappropriate ICD therapy and improve survival in primary prevention ICD patients.PubMedCrossRefGoogle Scholar
  35. 35.
    Schuger C, Daubert JP, Brown MW, Cannom D, Estes 3rd NA, Hall WJ, et al. Multicenter automatic defibrillator implantation trial: reduce inappropriate therapy (madit-rit): background, rationale, and clinical protocol. Ann Noninvasive Electrocardiol. 2012;17:176–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Gasparini M, Proclemer A, Klersy C, Kloppe A, Lunati M, Ferrer JB, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the advance iii randomized clinical trial. JAMA. 2013;309:1903–11.PubMedCrossRefGoogle Scholar
  37. 37.
    Saeed M, Razavi M, Neason CG, Petrutiu S. Rationale and design for programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock (provide) study. Europace. 2011;13:1648–52.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwab JO, Gasparini M, Lunati M, Proclemer A, Kaup B, Santi E, et al. Avoid delivering therapies for nonsustained fast ventricular tachyarrhythmia in patients with implantable cardioverter/defibrillator: the advance iii trial. J Cardiovasc Electrophysiol. 2009;20:663–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Saeed M, Neason CG, Razavi M, Chandiramani S, Alonso J, Natarajan S, et al. Programming antitachycardia pacing for primary prevention in patients with implantable cardioverter defibrillators: results from the prove trial. J Cardiovasc Electrophysiol. 2010;21:1349–54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Valentina Kutyifa
    • 1
    • 2
  • Wojciech Zareba
    • 1
  • Arthur J. Moss
    • 1
  1. 1.Heart Research Follow-Up ProgramUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Heart Research Follow-up Program, Cardiology DivisionUniversity of Rochester Medical CenterRochesterUSA

Personalised recommendations