One in three patients treated in line with ICD guidelines

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ICD implantation

A study of patients undergoing implantable cardioverter defibrillator (ICD) therapy across three centres, found that only one in three were treated in concordance with current guidelines on ICD device programming. This is the finding of research led by Teetouch Ananwattanasuk (University of Michigan, Ann Arbor, USA), published online in Heart Rhythm.

According to Teetouch and colleagues, inappropriate therapy is a common adverse effect in patients with ICDs, and can be avoided by appropriate programming. A 2015 expert consensus statement issued by the Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA), Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Society of Cardiac Stimulation and Electrophysiology (SOLAECE) sought to provide guidance on bradycardia programming, tachycardia detection, tachycardia therapy, and defibrillation testing for ICD patient treatment. A further 2019 update focused on optimal implantable cardioverter-defibrillator programming and testing.

Through the study, Teetouch and colleagues sought to assess the outcomes on device programming based on the 2015 expert consensus statement and the subsequent 2019 update.

Consecutive patients who underwent ICD for primary prevention during 2014­–2016 at three centres were included in the retrospective analysis. Patients were classified into two groups based on the tachycardia programming at the time of implant: guideline concordant group (GC) and non-guideline concordant group (NGC). Kaplan-Meier analysis and Cox proportional hazard models were used to estimate freedom from ICD therapy (ATP or shock), ICD shock and death.

A total of 772 patients were included in the study (mean age 63.3±13.8 years). Of this total, 258 patients (33.4%) were in GC group and 514 patients (66.6%) were in NGC group. During the mean follow up of 2.02±0.91 years, guideline concordant programming was associated with a 53% reduction in ICD therapy (p<0.01) and 50% reduction in ICD shock (p=0.02). Researchers found that there were no significant differences in mortality (6% in GC group vs. 11% in NGC group, (p=0.22).

The study concluded that only one in three of the studied population had an ICD device programmed in concordance with the current guidelines. “ICD programming based on the current guidelines was associated with a significantly lower rate of ICD therapy and shock without changes in mortality during intermediate-term follow up,” the researchers stated.


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