Reduction of inappropriate anti-tachycardia pacing therapies and shocks by a novel suite of detection algorithms in heart failure patients with cardiac resynchronization therapy defibrillators: A historical comparison of a prospective database

Maurizio Lunati, Alessandro Proclemer, Giuseppe Boriani, Maurizio Landolina, Emanuela Locati, Roberto Rordorf, Elisabetta Daleffe, Renato Pietro Ricci, Domenico Catanzariti, Luca Tomasi, Michele Gulizia, Maria Stella Baccillieri, Giulio Molon, Maurizio Gasparini

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Implantable cardioverter defibrillators improve survival of patients at risk for ventricular arrhythmias, but inappropriate shocks occur in up to 30% of patients and have been associated with worse quality of life and prognosis. In heart failure patients with cardiac resynchronization therapy defibrillators (CRT-Ds), we evaluated whether a new generation of detection and discrimination algorithms reduces inappropriate shocks. Methods and results We analysed 1983 Medtronic CRT-D patients (80% male, 67±10 years), 1368 with standard devices (Control CRTD) and 615 with new generation devices (New CRT-D). Expert electrophysiologists reviewed and classified the electrograms of all device-detected ventricular tachycardia/fibrillation episodes. Total follow-up was 3751 patients-years. Incidence of inappropriate shocks at 1 year was 2.8% [95% confidence interval (CI) = 2.0-3.5] in Control CRT-D and 0.9% (CI = 0.4-2.2) in New CRT-D (hazard ratio = 0.37, CI = 0.21-0.66, P < 0.001). In New CRT-D, inappropriate shocks were reduced by 77% [incidence rate ratio (IRR) = 0.23, CI = 0.16-0.35, P < 0.001] and inappropriate antitachycardia pacing by 81% (IRR = 0.19, CI = 0.11-0.335, P < 0.001). Annual rate per 100 patient-years for appropriate VF detections was 3.0 (CI = 2.1-4.2) in New CRT-D and 3.2 (CI = 2.1-5.0) in Control CRT-D (P = 0.68), for syncope was 0.4 (CI = 0.2-0.9) in New CRT-D and 0.7 (CI = 0.5-1.0) in Control CRT-D (P = 0.266), and for death was 1.0 (CI = 0.6-1.6) in New CRT-D and 3.5 (CI = 3.0-4.1) in Control CRT-D (P < 0.001). Conclusion Detection and discrimination algorithms used in new generation CRT-D significantly reduced inappropriate shocks when compared with standard CRT-D. This result, with no compromise on VF sensitivity or risk of syncope, has important implications for patients' quality of life and prognosis.

Original languageEnglish
Pages (from-to)1391-1398
Number of pages8
JournalEuropace
Volume18
Issue number9
DOIs
Publication statusPublished - 2016

Keywords

  • Anti-tachycardia pacing therapies
  • Cardiac resynchronization therapy
  • Implantable cardiac defibrillators
  • Shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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