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

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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., Daubert, J.P., Schuger, C., Goldenberg, I., Klein, H., Aktas, M.K., McNitt, S., Stockburger, M., Merkely, B., 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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