Abstract
Background
Implantable cardioverter defibrillators (ICDs) are typically programed with both ventricular tachycardia (VT) and ventricular fibrillation (VF) treatment zones. Biotronik and Abbott ICDs do not increment the VT counter when the tachycardia accelerates to the VF zone, which could result in a prolonged delay in tachycardia detection.
Methods
Patients with Biotronik and Abbott ICDs receiving care at Veterans Affairs facilities in Northern California were identified. Patient information and device tracings for patients with any ICD therapies were examined to assess for possible delayed tachycardia detection.
Results
Among 52 patients with Biotronik ICDs, 8 (15%) experienced appropriate ICD therapy over a median follow-up of 29 months. Among 68 patients with Abbott ICDs, 26 (38%) experienced appropriate ICD therapy over a median follow-up of 83 months. Three of the patients with Biotronik ICDs who received appropriate therapy experienced a delay in VT/VF detection due to the tachycardia rate oscillating between the VT and VF treatment zones (longest 31.2 s on detection), compared with four of the patients with Abbott ICDs (longest 4.1 s on the detection and 8 s on redetect). One of the patients with a Biotronik ICD experienced recurrent syncope associated with delayed detection and another died on the day of delayed detection. One of the patients with an Abbott ICD experienced syncope.
Conclusions
Because contemporary Biotronik and Abbott ICDs freeze the VT counters when tachycardia is in the VF zone, ICD therapies can be markedly delayed when the tachycardia oscillates between the VT and VF zone.
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Data Availability
All deidentified data generated or analysed during this study are included in this published article and its supplementary information files.
References
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72:e91–220.
Zhang X, Fan D, Srivatsa UN, Oesterle A. Implantable cardioverter-defibrillator shocks due to tachycardia with more atrial depolarizations than ventricular depolarizations with a far-field ventricular morphology shift: What is the mechanism? HeartRhythm Case Rep. 2021;7:59–62.
Ruwald AC, Sood N, Ruwald MH, et al. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT. J Cardiovasc Electrophysiol. 2013;24:672–9.
Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17.
Moss AJ, Schuger C, Beck CA, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:2275–83.
Gasparini M, Proclemer A, Klersy C, 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.
Tan VH, Wilton SB, Kuriachan V, Sumner GL, Exner DV. Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7:164–70.
Stiles MK, Fauchier L, Morillo CA, Wilkoff BL. 2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm. 2020;17:e220–8.
Acticor ProMRI Family of ICDs and CRT-Ds Technical Manual. 2021; https://manuals.biotronik.com/emanuals-professionals/?country=US&product=Icd/iShock/Acticor_US. Accessed 5/10/2022.
Muniyappa AN, Raitt MH, Judson GL, et al. Factors associated with remote monitoring adherence for cardiovascular implantable electronic devices. Heart Rhythm. 2022.
Safak E, Schmitz D, Konorza T, et al. Clinical efficacy and safety of an implantable cardioverter-defibrillator lead with a floating atrial sensing dipole. Pacing Clin Electrophysiol. 2013;36:952–62.
Sinha AM, Stellbrink C, Schuchert A, et al. Clinical experience with a new detection algorithm for differentiation of supraventricular from ventricular tachycardia in a dual-chamber defibrillator. J Cardiovasc Electrophysiol. 2004;15:646–52.
Geller JC, Wöhrle A, Busch M, et al. Reduction of inappropriate implantable cardioverter-defibrillator therapies using enhanced supraventricular tachycardia discriminators: the ReduceIT study. J Interv Card Electrophysiol. 2021;61:339–48.
Mukherjee RK, Sohal M, Shanmugam N, Pearse S, Jouhra F. Successful Identification of and discrimination between atrial and ventricular arrhythmia with the aid of pacing and defibrillator devices. Arrhythm Electrophysiol Rev. 2021;10:235–40.
Wilkoff BL, Ousdigian KT, Sterns LD, et al. 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.
Wilkoff BL, Williamson BD, Stern RS, 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.
Saeed M, Hanna I, Robotis D, et al. Programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock: results from the PROVIDE study. J Cardiovasc Electrophysiol. 2014;25:52–9.
Wilkoff BL, Fauchier L, Stiles MK, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm. 2016;13:e50-86.
Thøgersen AM, Larsen JM, Johansen JB, Abedin M, Swerdlow CD. Failure to treat life-threatening ventricular tachyarrhythmias in contemporary implantable cardioverter-defibrillators: implications for strategic programming. Circ Arrhythm Electrophysiol. 2017;10:e005305.
Oesterle A, Liem LB, Dhruva SS, et al. Traumatic syncope caused by prolonged ventricular arrhythmias with a defibrillator programmed to 2019 consensus recommendations. JACC: Clinical Electrophysiology. 2023.
Mansour F, Khairy P. ICD monitoring zones: intricacies, pitfalls, and programming tips. J Cardiovasc Electrophysiol. 2008;19:568–74.
Wilkoff BL, Sterns LD, Katcher MS, et al. Novel ventricular tachyarrhythmia detection enhancement detects undertreated life-threatening arrhythmias. Heart Rhythm. 2022;O2(3):70–8.
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This study was approved by the University of California San Francisco institutional review board. Informed consent was waived due to the retrospective nature of this study.
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AO—none; SSD—funding from the Department of Veterans Affairs, National Evaluation System for Health Technology Coordinating Center, Arnold Ventures, and National Institute for Health Care Management; CNP—none; BL—none; MHR—none.
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Oesterle, A., Dhruva, S.S., Pellegrini, C.N. et al. Ventricular arrhythmia detection for contemporary Biotronik and Abbott implantable cardioverter defibrillators with markedly prolonged detection in Biotronik devices. J Interv Card Electrophysiol 66, 1679–1691 (2023). https://doi.org/10.1007/s10840-023-01498-9
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DOI: https://doi.org/10.1007/s10840-023-01498-9