Standardized programming to reduce the burden of inappropriate therapies in implantable cardioverter defibrillators - Single centre follow up results

U Boles; E E Gul; L Fitzgerald; F Sadiq Ali; C Nolan; K Aldworth-Gaumond; D R Redfearn; A Baranchuk; B Glover; C Simpson; H Abdollah; K A Michael

doi:10.1016/j.ipej.2017.10.010

Standardized programming to reduce the burden of inappropriate therapies in implantable cardioverter defibrillators - Single centre follow up results

Indian Pacing Electrophysiol J. 2018 Mar-Apr;18(2):56-60. doi: 10.1016/j.ipej.2017.10.010. Epub 2017 Oct 27.

Authors

U Boles¹, E E Gul², L Fitzgerald³, F Sadiq Ali², C Nolan⁴, K Aldworth-Gaumond², D R Redfearn², A Baranchuk², B Glover², C Simpson², H Abdollah², K A Michael²

Affiliations

¹ Heart Rhythm Service, Division of Cardiology, Kingston General Hospital, Queen's University, Ontario, Canada; Cardiology Department, Midland Regional Hospital Mullingar (MRHM), Ireland. Electronic address: bolesu@tcd.ie.
² Heart Rhythm Service, Division of Cardiology, Kingston General Hospital, Queen's University, Ontario, Canada.
³ Cardiology Department, Midland Regional Hospital Mullingar (MRHM), Ireland.
⁴ Heart and Vascular Centre, Mater Private Hospital, Dublin, Ireland.

Abstract

Background: Current algorithms and device morphology templates have been proposed in current Implantable Cardioverter-Defibrillators (ICDs) to minimize inappropriate therapies (ITS), but this has not been completely successful.

Aim: Assess the impact of a deliberate strategy of using an atrial lead implant with standardized parameters; based on all current ICD discriminators and technologies, on the burden of ITS.

Method: A retrospective single-centre analysis of 250 patients with either dual chamber (DR) ICDs or biventricular ICDs (CRTDs) over a (41.9 ± 27.3) month period was performed. The incidence of ITS on all ICD and CRTD patients was chronicled after the implementation of standardized programming.

Results: 39 events of anti-tachycardial pacing (ATP) and/or shocks were identified in 20 patients (8% incidence rate among patients). The total number of individual therapies was 120, of which 34% were inappropriate ATP, and 36% were inappropriate shocks. 11 patients of the 250 patients received ITS (4.4%). Of the 20 patients, four had ICDs for primary prevention and 16 for a secondary prevention. All the episodes in the primary indication group were inappropriate, while seven patients (43%) of the secondary indication group experienced inappropriate therapies.

Conclusions: The burden of ITS in the population of patients receiving ICDs was 4.4% in the presence of atrial leads. The proposed rationalized programming criteria seems an effective strategy to minimize the burden of inappropriate therapies and will require further validation.

Keywords: Implantable cardioverter-defibrillator (ICDs); Inappropriate therapies; Standardized programming.