Although higher detection rates and delayed detection improve survival in implantable
cardioverter defibrillator clinical trials, their effectiveness in clinical practice
has limited validation. To evaluate the effectiveness of programming strategies for
reducing shocks and mortality, we conducted a nationwide assessment of patients with
implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators
with linked remote monitoring data. We categorized patients based on the presence
or absence of high rate detection and delayed detection: higher rate delayed detection
(HRDD), higher rate early detection (HRED), lower rate delayed detection (LRDD), and
lower rate early detection (LRED). Cox regression was used to compare mortality and
shock-free survival. There were 64,769 patients (age 68 ± 12 years; 27% female; 46%
cardiac resynchronization therapy defibrillator; follow-up 1.7 ± 1.1 years). In the
first year, 13% of HRDD, 14% of HRED, 18% of LRDD, and 20% in the LRED group experienced
a shock. After adjustment, HRDD was associated with lower risk of shock than HRED
(hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.002), LRDD
(HR 0.63, 95% CI 0.60 to 0.66, p <0.001), and LRED (HR 0.58, 95% CI 0.55 to 0.61,
p <0.001). HRDD was also associated with lower risk of mortality than HRED (adjusted
HR 0.80, 95% CI 0.75 to 0.86, p <0.001), LRDD (HR 0.76, 95% CI 0.70 to 0.83, p <0.001),
and LRED (HR 0.68, 95% CI 0.62 to 0.73, p <0.001). Similar results were observed in
patients with or without a shock in the first 6 months after implant. In conclusion,
high rate programming is associated with lower risk of shocks or death compared with
delayed detection. Optimal outcomes are observed in patients programmed with both
high rate and delayed detection.
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Article Info
Publication History
Published online: September 01, 2017
Accepted:
July 12,
2017
Received:
January 15,
2017
Footnotes
See page 1331 for disclosure information.
Identification
Copyright
© 2017 Published by Elsevier Inc.
