Immediate activation of stability and onset criteria after ICD implantation significantly reduced inappropriate therapies compared to no activation (13% vs 28%, P=0.029).
Case-Control (n=174)
Does the immediate activation of stability and onset criteria after ICD implantation reduce inappropriate therapies in patients with ICDs?
Immediate activation of stability and onset criteria after ICD implantation significantly reduces inappropriate therapies due to atrial fibrillation and sinus tachycardia, though there is a small risk of VT underdetection.
Absolute Event Rate: 13% vs 28%
p-value: p=0.029
INTRODUCTION: Inappropriate therapies are the most frequent adverse event in patients with implantable cardioverter defibrillators (ICDs). Most ICDs offer a stability criterion to discriminate ventricular tachycardia (VT) from atrial fibrillation and an onset criterion to discriminate VT from sinus tachycardia. The efficacy and safety of these criteria, if used immediately after implantation, is unknown. METHODS AND RESULTS: In a case control study, 87 patients in whom stability and onset criteria had been activated immediately after ICD implantation were matched to 87 patients in whom these criteria had not been activated. The groups were matched for known predictors of inappropriate therapies. With stability and onset criteria off, 24 patients (28%) received inappropriate therapies due to atrial fibrillation (n = 14) or sinus tachycardia (n = 11); with stability and onset on, only 11 patients (13%) were treated by the ICD due to atrial fibrillation (n = 5) or sinus tachycardia (n = 7) (log rank: P = 0.029). Five patients suffered inappropriate therapies despite the fact that onset (n = 4) or stability (n = 1) criteria were not fulfilled once tachycardias continued for a prespecified duration. Only one patient experienced a failure to detect VT due to the onset criterion; none because of stability. CONCLUSION: The immediate use of stability and onset criteria after ICD implantation reduces inappropriate therapies due to atrial fibrillation and sinus tachycardia. Because of the potential for underdetection of VT, this approach should be limited to tachycardia rates hemodynamically tolerated by the patient.
Weber et al. (Mon,) conducted a case-control in Patients with implantable cardioverter defibrillators (ICDs) (n=174). Immediate activation of stability and onset criteria vs. Stability and onset criteria not activated was evaluated on Inappropriate therapies due to atrial fibrillation or sinus tachycardia (p=0.029). Immediate activation of stability and onset criteria after ICD implantation significantly reduced inappropriate therapies compared to no activation (13% vs 28%, P=0.029).