Reducing Unnecessary Implantable Cardioverter‐Defibrillator Therapy With ENHANCED Programming: Long‐Term Outcomes of the ENHANCED‐ICD Study

Background Advances in implantable cardioverter‐defibrillator (ICD) programming strategies have achieved significant reductions in inappropriate shocks. However, further refinement is needed to minimize appropriate but unnecessary therapies. The ENHANCED‐ICD study initially demonstrated the short‐term safety and efficacy of programming a number of intervals to detect (NID) of 60/80 over a median follow‐up of 1.3 years. A decade later, this study presents the long‐term impacts of this programming strategy. Objective To assess the long‐term impact of programming NID 60/80 for ventricular tachycardia (VT)/ventricular fibrillation (VF) detection on adverse events related to shocks and arrhythmias, as well as on ICD therapies—both delivered and avoided. Methods A retrospective analysis was conducted on 60 patients from the ENHANCED‐ICD study, a prospective, single‐center trial. The median age was 60 years, 78% were men, and 53% had a primary prevention ICD indication. A prolonged detection interval of NID 60/80 was programmed for VT/VF detection. The cycle lengths for VT/fast VT/VF were set at 360/330/240 ms, respectively. Results After a median follow‐up of 9.4 years, Enhanced programming prevented unnecessary ICD therapies in 16.7% of patients and reduced the overall therapy rate by 25.9%. A total of 26.7% of patients received ICD therapy, with appropriate therapy delivered in 23.3% and inappropriate therapy occurring in 3.3% of patients. No arrhythmic deaths were observed, while syncope was reported in 10.0% of patients (1.63 per 100 patient‐years). Conclusion Prolonging the ICD detection interval to an NID of 60/80 successfully prevented appropriate but unnecessary therapy, while maintaining safety during long‐term follow‐up. Trial Registration: The ENHANCED‐ICD study registered on http://ClinicalTrials.gov under study ID NCT01715116.