Key result
Optimizing ICD programming by lengthening detection intervals and using higher rate thresholds can significantly reduce mortality, but uptake of guideline-directed programming remains limited.
There is a critical need to increase the uptake of guideline-directed ICD programming (longer detection intervals and higher rate thresholds) to reduce inappropriate therapies and mortality.
Primary prevention implantable cardioverter-defibrillators (ICDs) with short detection intervals lead to increased inappropriate therapies. Both appropriate and inappropriate shocks are associated with higher mortality. Optimizing programming (lengthening detection intervals, higher rate thresholds) can significantly reduce mortality. Despite publication of the HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on ICD programming in 2015 (updated 2019), uptake of guideline-directed programming has been limited.
No takes yet. Share an insight, caveat, or question.
Evans et al. (2026) conducted an editorial in Primary prevention implantable cardioverter-defibrillators. Guideline-directed ICD programming (lengthening detection intervals, higher rate thresholds) vs. Short detection intervals / non-guideline programming was evaluated. Optimizing ICD programming by lengthening detection intervals and using higher rate thresholds can significantly reduce mortality, but uptake of guideline-directed programming remains limited.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: