DDDR AVSH programming was noninferior to VVI programming for all-cause mortality and heart failure hospitalizations (6.4% vs 9.5%; RR 0.67; P<0.001 for noninferiority).
RCT (n=988)
randomized
Yes
Does dual-chamber rate-responsive programming with AV search hysteresis improve outcomes compared to single-chamber VVI programming in patients with an ICD?
Relative Risk: 0.67
Absolute Event Rate: 6.4% vs 9.5%
p-value: p=<0.001 for noninferiority
BACKGROUND: The INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AVSH in ICDs) study tested the hypothesis that dual-chamber rate-responsive (DDDR) with atrioventricular search hysteresis (AVSH) 60-130 programming is not inferior to single-chamber (VVI)-40 programming in an implantable cardioverter defibrillator with respect to all-cause mortality and heart failure hospitalizations using an equivalence margin of 5%. METHODS AND RESULTS: At 108 centers, 1530 patients with an implantable cardioverter defibrillator indication received a VITALITY AVT (Guidant Corporation, St. Paul, Minn) implantable cardioverter defibrillator programmed consistently to DDDR AVSH 60-130 for the first week. Of those, 988 patients with I (79%). A total of 32 patients (6.4%) in the DDDR AVSH arm and 46 patients (9.5%) in the VVI arm died or were hospitalized for heart failure during a mean follow-up of 10.4 months (relative risk=0.67, P=0.072 in favor of DDDR AVSH). DDDR AVSH was not inferior to VVI programming (P<0.001). All-cause mortality was not significantly different between the DDDR AVSH arm (3.6%) and the VVI arm (5.1%; P=0.23). The mean percent right ventricular pacing in the DDDR AVSH arm was 10% (median 4%) versus 3% (median 0%) in the VVI arm. CONCLUSIONS: In the INTRINSIC RV trial, among those randomized, DDDR AVSH was associated with similar outcomes as with VVI backup pacing.
Olshansky et al. (Tue,) conducted a rct in Implantable cardioverter defibrillator indication (n=988). DDDR AVSH 60-130 programming vs. VVI-40 programming was evaluated on All-cause mortality and heart failure hospitalizations (RR 0.67, p=<0.001 for noninferiority). DDDR AVSH programming was noninferior to VVI programming for all-cause mortality and heart failure hospitalizations (6.4% vs 9.5%; RR 0.67; P<0.001 for noninferiority).