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Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines.

Methods

Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality.

Results

A total of 488 patients were included (mean age, 66 ± 13 years). During a mean follow-up of 1.9 ± 0.9 years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42–0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34–1.52) or mortality (aHR 1.19, 95% CI, 0.47–3.05).

Conclusions

Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.

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Data availability

Data are available on request from the authors.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand

    Padoemwut Teerawongsakul & Teetouch Ananwattanasuk

  2. Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA

    Padoemwut Teerawongsakul, Teetouch Ananwattanasuk, Muazzum Shah, Sangeeta Lathkar-Pradhan, Hakan Oral & Krit Jongnarangsin

  3. Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Cardiac Center, Bangkok, Thailand

    Ronpichai Chokesuwattanaskul

  4. Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA

    Waseem Barham & Ranjan K. Thakur

  5. Division of Cardiovascular Medicine, Indiana University School of Medicine, 1800 N Capitol Ave, Room E300B, Indianapolis, IN, 46202, USA

    Tanyanan Tanawuttiwat

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  1. Padoemwut Teerawongsakul
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Correspondence to Tanyanan Tanawuttiwat.

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Teerawongsakul, P., Ananwattanasuk, T., Chokesuwattanaskul, R. et al. Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines. J Interv Card Electrophysiol 66, 1359–1366 (2023). https://doi.org/10.1007/s10840-022-01431-6

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