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Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: a MADIT-RIT sub-study

Item Type:Article
Title:Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: a MADIT-RIT sub-study
Creators Name:Kutyifa, V. and Daubert, J.P. and Schuger, C. and Goldenberg, I. and Klein, H. and Aktas, M.K. and McNitt, S. and Stockburger, M. and Merkely, B. and Zareba, W. and Moss, A.J.
Abstract:BACKGROUND: The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT. METHODS AND RESULTS: The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; P<0.001). High-rate cut-off or delayed ventricular tachycardia therapy programming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; P<0.001 for all). There was a significant reduction in inappropriate anti-tachycardia pacings in both group and a significant reduction in inappropriate ICD shock in CRT-D patients. CONCLUSIONS: Patients implanted with a CRT-D have lower risk of inappropriate ICD therapy than those with an ICD. Innovative ICD programming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov; Unique identifier: NCT00947310.
Keywords:Atrial Fibrillation, Cardiac Resynchronization Therapy, ICD Programming, Implantable Cardioverter-Defibrillator, MADIT-RIT, Supraventricular Tachycardia
Source:Circulation Arrhythmia and Electrophysiology
ISSN:1941-3149
Publisher:Lippincott Williams & Wilkins
Volume:9
Number:1
Page Range:e001965
Date:January 2016
Official Publication:https://doi.org/10.1161/CIRCEP.114.001965
PubMed:View item in PubMed

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