Reprogramming the tachycardia parameters with long-detection strategy in patients with pre-existing implantable cardioverter-defibrillator

• Published in: Acta Cardiologica Vol. 74; no. 3; pp. 246 - 251
• Main Authors: Bozyel, Serdar, Aktas, Mujdat, Mutluer, Ferit Onur, Guler, Tumer Erdem, Dervis, Emir, Argan, Onur, Celikyurt, Umut, Agir, Aysen, Vural, Ahmet
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 04-05-2019
• Subjects: Action Potentials; Aged; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Electric Countershock - adverse effects; Electric Countershock - instrumentation; Female; Heart Rate; Humans; Implantable cardioverter-defibrillator; long detection strategy; Male; Middle Aged; Primary Prevention - instrumentation; Prospective Studies; Prosthesis Design; Prosthesis Failure; reprogramming; shock reduction; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Time Factors; Treatment Outcome; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - mortality; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy; reprogramming; shock reduction; Implantable cardioverter-defibrillator; long detection strategy
• ISSN: 0001-5385; 1784-973X; 0373-7934
• DOI: 10.1080/00015385.2018.1488664

Background: A long-detection interval (LDI) programming has been proved to reduce shock therapy in patients who underwent de novo implantable cardioverter defibrillator (ICD) implantation. We aimed to evaluate effectiveness and safety of this new strategy in old ICD recipients.
Methods: We included 147 primary prevention patients with ischaemic and non-ischaemic aetiology. Conventional setting parameters (18 of 24 intervals to detect ventricular arrhythmias (VA's)) were reprogrammed with LDI strategy (30 of 40 intervals to detect VA's). One monitoring zone (between 360 and 330 ms) and two therapy zones were programmed, treating all rhythms of cycle length <330 ms that met the duration criterion of 30/40 intervals and were discriminated as ventricular tachycardia/ventricular fibrillation (VT/VF). The supraventricular tachycardia (SVT) discriminators were used in all patients.
Results: At a median follow-up of 24 months, 12.9% (n = 19) of patients received shock therapies (± antitachycardia pacing (ATP)). Appropriate and inappropriate shocks occurred in 7.5 and 5.4% of patients during follow-up, respectively. Only one patient experienced an arrhythmic syncope during the follow-up period. There was no death related to LDI programming. The LDI programming helped to stop unnecessary in 10 patients (6.8%), who otherwise would have been treated in the conventional programming.
Conclusions: LDI programming was found safe and effective. Hence, old ICD recipients will benefit from this strategy.