Programming an ICD: It’s time to change the defaults

Programming an ICD: It's time to change the defaults In this edition of the journal, Boles et al. report on the inappropriate and appropriate therapy rates among 250 patients (200 for secondary prevention, 50 for primary prevention) who received a dual chamber ICD or a CRTD [1].The devices were programmed as follows: VT1 zone ¼ 170e200 bpm (for primary prevention), or VTCL e 20 ms (secondary prevention), VT 2 zone ¼ 200e250 bpm, VF zone ¼ > 250 bpm.This is comparable to the recommendations in the 2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing which advocate the slowest tachycardia rate to be 188 bpm for primary prevention, and VTCL-10 bpm for secondary prevention [2].The NID of 28e30 beats is also very similar to the 2015 recommendation of 30 beats, and is comparable to the NID used in the PREPARE, RELEVANT, ADVANCE III and PRO-VIDE studies [3e6].The time to detect (in devices from Boston Scientific) used in this study was shorter than the 30 second time delay advocated by the 2015 Consensus; the number of Boston Scientific devices in this study, though, were limited.Among the SVT-VT discriminators, the authors have suggested that the onset and stability criteria be turned off.It would make sense to retain these criteria as "ON" in patients with AV block, or poor AV nodal conduction.The authors have used up to 6 bursts of ATP in the VT1 zone, and 3 in the VT2 zone.Martins et al. have previously reported that