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Programming tachycardia zones to reduce avoidable defibrillator shocks
Session:
Painel 5 - Arritmologia 8
Speaker:
Rita Marinheiro
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Posters
FP Number:
---
Authors:
Rita Marinheiro; Leonor Parreira; Pedro Campos Amador; Dinis Valbom Mesquita; Claudia Lopes; José Maria Farinha; Marta Ferreira Fonseca; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Joana Silva Ferreira; Rui Caria
Abstract
<p><strong>Introduction</strong>:</p> <p>In recent years, there is an increased awareness of the frequency and the adverse outcomes associated with avoidable implantable cardioverter-defibrillator (ICD) therapy. Most of these avoidable ICD therapies can be reduced by evidence-based programming, but defining tachycardia settings across all device manufacturers is not straightforward.</p> <p> </p> <p><strong>Objectives</strong>: to determine if a homogeneous programming of tachycardia zones, independently of the manufacturer, result in a lower rate of avoidable shocks in heart failure (HF) patients with a primary-prevention indication for a defibrillator. We also aimed to find if programming high rate or delayed therapies can have some benefit over the other. </p> <p> </p> <p><strong>Methods</strong>: Since 2017 we randomly assigned consecutive HF patients with a primary-prevention indication for defibrillator to receive one of two programming configurations (panel A) - “new programming” (NP) group. Between 2015 and 2017, we retrospectively analyzed patients in whom tachycardia zones programming had been left to physician consideration - “conventional programming” (CP) group. We included patients with <em>de novo</em> ICD or cardiac resynchronization therapy with defibrillator (CRT-D) implantation and those with previous implanted defibrillators with no indication for an individualized programming (e.g. previous VT or shock). We compared the rate of appropriate and inappropriate therapies (shocks and ATP) in CP and NP groups and also in high rate versus delayed therapies groups. We also evaluated syncopal episodes and all-cause mortality during the follow-up.</p> <p> </p> <p><strong>Results:</strong> Two-hundred and four patients [median age 66 (IQR 59-71), 82% male, 61% with ischemic heart disease) were evaluated: 91 patients were assigned for NP group [high rate (n=47) or delayed therapy (n=44)] and they were compared with 113 patients with CP. During a median follow-up of 20 (IQR 16-22) months, 35 patients (17%) had a first occurrence of appropriate or inappropriate therapy (panel B). New programming as compared with conventional programming was associated with a reduction in all ICD therapies, appropriate therapy and appropriate ATP, but not with inappropriate therapies (panel C and D). The risk of all-cause mortality was not different between the groups (panel C). Syncope did not occur in any group. In NP group, high-rate versus delayed programming was not significantly associated with a different incidence of appropriate (p=0.68) or inappropriate therapy (p=0.45).</p> <p> </p> <p><strong>Conclusion:</strong> In our study, programming tachycardia zones homogeneously across all manufacturers resulted in a lower rate of “appropriate” but potentially avoidable therapies, mainly due to the reduced number of ATP. Despite recognizing the reduced number of events, there were no differences in the incidence of ICD therapies comparing high-rate versus delayed therapies.</p>
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