In patients with coronary disease and asymptomatic NSVT, ICD detections occurred in 35%, with appropriate therapy for sustained VT/VF in 22% and inappropriate therapy in 10% over 13.1 months.
Observational (n=51)
Does implantable cardioverter defibrillator therapy provide appropriate therapy for life-threatening arrhythmias in patients with coronary disease, reduced left ventricular function, and asymptomatic nonsustained ventricular tachycardia?
Patients with coronary disease, reduced LV function, and asymptomatic NSVT commonly receive appropriate ICD therapy, supporting its use for primary prevention alongside careful programming to minimize inappropriate shocks.
Primary prevention trials have demonstrated that patients with coronary disease, reduced left ventricular function, and nonsustained ventricular tachycardia (NSVT) have improved survival with implantable cardioverter defibrillator (ICD) therapy, presumably secondary to effective termination of life-threatening arrhythmias. However, stored intracardiac electrograms were not always available and specific arrhythmias leading to ICD therapy were not always known. We examined the occurrence of ICD events in 51 consecutive patients who match the described patient profile to determine the frequency of appropriate and inappropriate ICD therapy. ICD detections were noted in 18 (35%) patients during a median follow-up period of 13.1 months. Appropriate therapy for sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) occurred in 11 (22%) patients, with appropriate shocks in 8 (16%) patients and appropriate antitachycardia pacing (ATP) in 4 (8%) patients. The time to first appropriate therapy occurred at a mean of 17 +/- 12 months (median 18 months, range 3-36 months). Inappropriate therapy occurred in 5 (10%) patients with inappropriate shocks in 4 patients and inappropriate ATP in 2 patients. Inappropriate therapy was delivered for supraventricular arrhythmias (SVAs) in 4 patients and for T wave oversensing in 1 patient. The reason for shock therapy was unknown in 1 patient (2%) due to ICD malfunction. The mean arrhythmia rate leading to appropriate therapy for VT/VF was 232 +/- 72 beats/min (range 181-400 beats/min), and the mean rate leading to inappropriate therapy for SVT was 168 +/- 10 beats/min (range 160-180 beats/min). Patients with coronary disease and asymptomatic NSVT commonly receive appropriate defibrillator therapy. These results support the need for ICD implantation for primary prevention, with attention to careful programming of the detection rate to prevent inappropriate therapy.
Russo et al. (Mon,) conducted a observational in Asymptomatic nonsustained ventricular tachycardia with coronary disease and reduced left ventricular function (n=51). Implantable cardioverter defibrillator (ICD) was evaluated on Frequency of appropriate and inappropriate ICD therapy. In patients with coronary disease and asymptomatic NSVT, ICD detections occurred in 35%, with appropriate therapy for sustained VT/VF in 22% and inappropriate therapy in 10% over 13.1 months.