Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality
Background:Implantable cardioverter defibrillator (ICD) therapies, even when appropriate, are associated with increased risk. Therapy-reducing strategies have been shown to reduce the mortality rate.Methods and Results:In total, 895 patients with ICD and cardiac resynchronization therapy with defibr...
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| Veröffentlicht in: | Circulation Journal 2021/02/25, Vol.85(3), pp.291-299 |
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| creator | Schober, Alexander Daniel Schober, Andreas Leonhard Hubauer, Ute Fredersdorf, Sabine Seegers, Joachim Keyser, Andreas Stadler, Stefan Birner, Christoph Maier, Lars Jungbauer, Carsten Ücer, Ekrem |
| description | Background:Implantable cardioverter defibrillator (ICD) therapies, even when appropriate, are associated with increased risk. Therapy-reducing strategies have been shown to reduce the mortality rate.Methods and Results:In total, 895 patients with ICD and cardiac resynchronization therapy with defibrillation function (CRT-D) were included in the study; of these, 506 (57%) patients undergoing secondary prevention were included. Devices implanted before May 2014 were programmed according to conventional programming (CP), the others according to our novel programming (NP) with high rate cut-off, longer detection intervals and 4–6 anti-tachycardia pacing (ATP) trains in the ventricular tachycardia (VT) zone. Time-to-first-event for mortality, appropriate and inappropriate therapies were analyzed. Follow-up time was 24.0 months (IQR 13.0–24.0 months). There was a significant reduction in mortality rate (11.4% vs. 25.4%, P |
| doi_str_mv | 10.1253/circj.CJ-20-0940 |
| format | Article |
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Therapy-reducing strategies have been shown to reduce the mortality rate.Methods and Results:In total, 895 patients with ICD and cardiac resynchronization therapy with defibrillation function (CRT-D) were included in the study; of these, 506 (57%) patients undergoing secondary prevention were included. Devices implanted before May 2014 were programmed according to conventional programming (CP), the others according to our novel programming (NP) with high rate cut-off, longer detection intervals and 4–6 anti-tachycardia pacing (ATP) trains in the ventricular tachycardia (VT) zone. Time-to-first-event for mortality, appropriate and inappropriate therapies were analyzed. Follow-up time was 24.0 months (IQR 13.0–24.0 months). There was a significant reduction in mortality rate (11.4% vs. 25.4%, P<0.001) and in the rate of appropriate (18.8% vs. 42.2%, P<0.001) and inappropriate therapies (5.2% vs. 18.0%, P<0.001) with NP according to Kaplan-Meier analyses. In multivariate analysis, NP (hazard ratio [HR]=0.35; P<0.001), chronic kidney disease (HR=1.55), reduced ejection fraction (EF) (HR=1.35), secondary ICD indication (HR=2.35) and age at implantation (HR=1.02) were associated with mortality reduction. NP was also associated with significant reduction in the rate of appropriate and inappropriate therapies. These results were consistent after stratification for primary and secondary prevention.Conclusions:Novel ICD programming reduced mortality and morbidity due to appropriate or inappropriate ICD therapies in secondary as well as in primary ICD indication.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-20-0940</identifier><identifier>PMID: 33563865</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Atrial Fibrillation - mortality ; Atrial Fibrillation - prevention & control ; Cardiac Resynchronization Therapy ; Defibrillator ; Defibrillators, Implantable ; Electric Countershock ; Humans ; Kaplan-Meier Estimate ; Mortality ; Novel ; Programming ; Tachycardia, Ventricular - therapy</subject><ispartof>Circulation Journal, 2021/02/25, Vol.85(3), pp.291-299</ispartof><rights>2021, THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-9ba9dbcbe65b5c3f3b27a8cbf02c983d266662f2a2b71e8a5cb9d0ba72994ddd3</citedby><cites>FETCH-LOGICAL-c494t-9ba9dbcbe65b5c3f3b27a8cbf02c983d266662f2a2b71e8a5cb9d0ba72994ddd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1883,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33563865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schober, Alexander Daniel</creatorcontrib><creatorcontrib>Schober, Andreas Leonhard</creatorcontrib><creatorcontrib>Hubauer, Ute</creatorcontrib><creatorcontrib>Fredersdorf, Sabine</creatorcontrib><creatorcontrib>Seegers, Joachim</creatorcontrib><creatorcontrib>Keyser, Andreas</creatorcontrib><creatorcontrib>Stadler, Stefan</creatorcontrib><creatorcontrib>Birner, Christoph</creatorcontrib><creatorcontrib>Maier, Lars</creatorcontrib><creatorcontrib>Jungbauer, Carsten</creatorcontrib><creatorcontrib>Ücer, Ekrem</creatorcontrib><title>Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:Implantable cardioverter defibrillator (ICD) therapies, even when appropriate, are associated with increased risk. Therapy-reducing strategies have been shown to reduce the mortality rate.Methods and Results:In total, 895 patients with ICD and cardiac resynchronization therapy with defibrillation function (CRT-D) were included in the study; of these, 506 (57%) patients undergoing secondary prevention were included. Devices implanted before May 2014 were programmed according to conventional programming (CP), the others according to our novel programming (NP) with high rate cut-off, longer detection intervals and 4–6 anti-tachycardia pacing (ATP) trains in the ventricular tachycardia (VT) zone. Time-to-first-event for mortality, appropriate and inappropriate therapies were analyzed. Follow-up time was 24.0 months (IQR 13.0–24.0 months). There was a significant reduction in mortality rate (11.4% vs. 25.4%, P<0.001) and in the rate of appropriate (18.8% vs. 42.2%, P<0.001) and inappropriate therapies (5.2% vs. 18.0%, P<0.001) with NP according to Kaplan-Meier analyses. In multivariate analysis, NP (hazard ratio [HR]=0.35; P<0.001), chronic kidney disease (HR=1.55), reduced ejection fraction (EF) (HR=1.35), secondary ICD indication (HR=2.35) and age at implantation (HR=1.02) were associated with mortality reduction. NP was also associated with significant reduction in the rate of appropriate and inappropriate therapies. These results were consistent after stratification for primary and secondary prevention.Conclusions:Novel ICD programming reduced mortality and morbidity due to appropriate or inappropriate ICD therapies in secondary as well as in primary ICD indication.</description><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - prevention & control</subject><subject>Cardiac Resynchronization Therapy</subject><subject>Defibrillator</subject><subject>Defibrillators, Implantable</subject><subject>Electric Countershock</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Mortality</subject><subject>Novel</subject><subject>Programming</subject><subject>Tachycardia, Ventricular - therapy</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU9PHCEYxidNm2pt7z01HHvoWAbmH0czVl2zVmNseiQv8M4um_mzAmOy38aPWsbdKgcg8Ht-hDxJ8jWjpxkr-E9tnd6cNtcpoykVOX2XHGc8r9K8ZvT9y75MRZ3zo-ST9xtKmaCF-JgccV6UvC6L4-T59_iEHVn02w6GAKpD0oAzNp66gI6cY2uVs10HYXTkzo0rB31vhxX5a8OaXNnVmtxDiKkppLdt-4Msx3h5jgF1sONAFkPUPEHnCQyG3ExdsNv4yNkQbPoAer3T83NA7kDP1ns0k0ZPbkYXoLNh9zn50MY0fjmsJ8mfi18PzVW6vL1cNGfLVOciD6lQIIzSCstCFZq3XLEKaq1ayrSouWFlHKxlwFSVYQ2FVsJQBRUTIjfG8JPk-967dePjhD7I3nqN8eMDjpOXLK_rrBRVVkaU7lHtRu8dtnLrbA9uJzMq517kSy-yuZaMyrmXGPl2sE-qR_Ma-F9EBC72wMYHWOErAC5Y3eHBWBeSz9Ob-Q1Yg5M48H_kJadC</recordid><startdate>20210225</startdate><enddate>20210225</enddate><creator>Schober, Alexander Daniel</creator><creator>Schober, Andreas Leonhard</creator><creator>Hubauer, Ute</creator><creator>Fredersdorf, Sabine</creator><creator>Seegers, Joachim</creator><creator>Keyser, Andreas</creator><creator>Stadler, Stefan</creator><creator>Birner, Christoph</creator><creator>Maier, Lars</creator><creator>Jungbauer, Carsten</creator><creator>Ücer, Ekrem</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210225</creationdate><title>Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality</title><author>Schober, Alexander Daniel ; Schober, Andreas Leonhard ; Hubauer, Ute ; Fredersdorf, Sabine ; Seegers, Joachim ; Keyser, Andreas ; Stadler, Stefan ; Birner, Christoph ; Maier, Lars ; Jungbauer, Carsten ; Ücer, Ekrem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-9ba9dbcbe65b5c3f3b27a8cbf02c983d266662f2a2b71e8a5cb9d0ba72994ddd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - prevention & control</topic><topic>Cardiac Resynchronization Therapy</topic><topic>Defibrillator</topic><topic>Defibrillators, Implantable</topic><topic>Electric Countershock</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Mortality</topic><topic>Novel</topic><topic>Programming</topic><topic>Tachycardia, Ventricular - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schober, Alexander Daniel</creatorcontrib><creatorcontrib>Schober, Andreas Leonhard</creatorcontrib><creatorcontrib>Hubauer, Ute</creatorcontrib><creatorcontrib>Fredersdorf, Sabine</creatorcontrib><creatorcontrib>Seegers, Joachim</creatorcontrib><creatorcontrib>Keyser, Andreas</creatorcontrib><creatorcontrib>Stadler, Stefan</creatorcontrib><creatorcontrib>Birner, Christoph</creatorcontrib><creatorcontrib>Maier, Lars</creatorcontrib><creatorcontrib>Jungbauer, Carsten</creatorcontrib><creatorcontrib>Ücer, Ekrem</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schober, Alexander Daniel</au><au>Schober, Andreas Leonhard</au><au>Hubauer, Ute</au><au>Fredersdorf, Sabine</au><au>Seegers, Joachim</au><au>Keyser, Andreas</au><au>Stadler, Stefan</au><au>Birner, Christoph</au><au>Maier, Lars</au><au>Jungbauer, Carsten</au><au>Ücer, Ekrem</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2021-02-25</date><risdate>2021</risdate><volume>85</volume><issue>3</issue><spage>291</spage><epage>299</epage><pages>291-299</pages><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background:Implantable cardioverter defibrillator (ICD) therapies, even when appropriate, are associated with increased risk. Therapy-reducing strategies have been shown to reduce the mortality rate.Methods and Results:In total, 895 patients with ICD and cardiac resynchronization therapy with defibrillation function (CRT-D) were included in the study; of these, 506 (57%) patients undergoing secondary prevention were included. Devices implanted before May 2014 were programmed according to conventional programming (CP), the others according to our novel programming (NP) with high rate cut-off, longer detection intervals and 4–6 anti-tachycardia pacing (ATP) trains in the ventricular tachycardia (VT) zone. Time-to-first-event for mortality, appropriate and inappropriate therapies were analyzed. Follow-up time was 24.0 months (IQR 13.0–24.0 months). There was a significant reduction in mortality rate (11.4% vs. 25.4%, P<0.001) and in the rate of appropriate (18.8% vs. 42.2%, P<0.001) and inappropriate therapies (5.2% vs. 18.0%, P<0.001) with NP according to Kaplan-Meier analyses. In multivariate analysis, NP (hazard ratio [HR]=0.35; P<0.001), chronic kidney disease (HR=1.55), reduced ejection fraction (EF) (HR=1.35), secondary ICD indication (HR=2.35) and age at implantation (HR=1.02) were associated with mortality reduction. NP was also associated with significant reduction in the rate of appropriate and inappropriate therapies. These results were consistent after stratification for primary and secondary prevention.Conclusions:Novel ICD programming reduced mortality and morbidity due to appropriate or inappropriate ICD therapies in secondary as well as in primary ICD indication.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>33563865</pmid><doi>10.1253/circj.CJ-20-0940</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Atrial Fibrillation - mortality Atrial Fibrillation - prevention & control Cardiac Resynchronization Therapy Defibrillator Defibrillators, Implantable Electric Countershock Humans Kaplan-Meier Estimate Mortality Novel Programming Tachycardia, Ventricular - therapy |
| title | Novel Implantable Cardioverter Defibrillator Programming With High Rate Cut-Off, Long Detection Intervals and Multiple Anti-Tachycardia Pacing Reduces Mortality |
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