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Programming implantable cardioverter–defibrillator in primary prevention: Guideline concordance and outcomes

2020; Elsevier BV; Volume: 17; Issue: 7 Linguagem: Inglês

10.1016/j.hrthm.2020.02.004

1556-3871

Teetouch Ananwattanasuk, Tanyanan Tanawuttiwat, Ronpichai Chokesuwattanaskul, Sangeeta Lathkar‐Pradhan, Waseem Barham, Hakan Oral, Ranjan K. Thakur, Krit Jongnarangsin,

Cardiac Arrhythmias and Treatments

Background Inappropriate therapy is a common adverse effect in patients with an implantable cardioverter–defibrillator (ICD) that may be prevented by appropriate programming. Objective The purpose of this study was to assess the outcomes of device programming based on a 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and a 2019 focused update on optimal ICD programming and testing. Methods Consecutive patients who underwent ICD insertion for primary prevention from 2014–2016 at 3 centers were included in the retrospective analysis. Patients were classified into 2 groups based on the tachycardia programming at the time of implant: guideline concordant group (GC) and non-guideline concordant group (NGC). Kaplan–Meier analysis and Cox proportional hazard models were used to estimate freedom from ICD therapy (antitachycardia pacing or shock), ICD shock, and death. Results A total of 772 patients were included in the study (mean age 63.3 ± 13.8 years). Of this total, 258 patients (33.4%) were in the GC group and 514 patients (66.6%) were in the NGC group. During mean follow-up of 2.02 ± 0.91 years, guideline concordant programming was associated with a 53% reduction in ICD therapy ( P <.01) and 50% reduction in ICD shock ( P = .02). There were no significant differences in mortality (6% in GC group vs11% in NGC group; P = .22). Conclusion Only one-third of the studied population had an ICD device programmed in concordance with current guidelines. ICD programming based on the current guidelines was associated with a significantly lower rate of ICD therapy and shock without changes in mortality during intermediate-term follow-up.