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SVT discrimination algorithms significantly reduce the rate of inappropriate therapy in the setting of modern day delayed high-rate detection programming


Cheng, Alan; Auricchio, Angelo; Schloss, Edward J; Kurita, Takashi; Sterns, Laurence D; Gerritse, Bart; Brown, Mark L; Fagan, Dedra H; Lexcen, Daniel R; Ellenbogen, Kenneth A (2019). SVT discrimination algorithms significantly reduce the rate of inappropriate therapy in the setting of modern day delayed high-rate detection programming. Journal of cardiovascular electrophysiology:Epub ahead of print.

Abstract

BACKGROUND
Contemporary ICD programming involving delayed high-rate detection and use of SVT discriminators has significantly reduced the rate of inappropriate shocks. The extent to which SVT algorithms alone reduce inappropriate therapies is poorly understood.
METHODS AND RESULTS
PainFree SST enrolled 2,770 patients with a single or dual-chamber ICD or cardiac resynchronization defibrillator. Patients were followed for 22±9 months with SVT discriminators on in 96% of patients. Sustained ventricular tachyarrhythmias and SVT episodes were adjudicated by an independent physician committee. For this analysis, all episodes were subjected to post-processing computer simulation with SVT discriminators off with and without delayed high-rate detection criteria (VF zone only, 30/40@320ms). There were 3,282 adjudicated SVT episodes of which 115 resulted in an ICD shock and 113 received only ATP (2-year inappropriate shock and therapy rates of 3.1% and 4.1%). Therapy was appropriately withheld for the remaining 3,054 SVT episodes. With both SVT discriminators and delayed high-rate detection simulated off, the 2-year inappropriate therapy rate would have been 22.9% (Hazard Ratio [HR]=6.24, 95% confidence interval [CI]: 5.20-7.49). With SVT discriminators simulated off and delayed high-rate detection simulated on in all patients, the 2-year rate would have been 6.4% (HR=1.63, CI: 1.44-1.85).
CONCLUSIONS
Use of SVT discriminators has a significant role in reducing the rate of inappropriate ICD therapy even in the setting of delayed high-rate detection settings. Deactivating SVT discriminators would have resulted in an overall increase in the inappropriate ICD therapy rate by 63% and 524% with and without delayed high-rate detection programming, respectively. This article is protected by copyright. All rights reserved.

Abstract

BACKGROUND
Contemporary ICD programming involving delayed high-rate detection and use of SVT discriminators has significantly reduced the rate of inappropriate shocks. The extent to which SVT algorithms alone reduce inappropriate therapies is poorly understood.
METHODS AND RESULTS
PainFree SST enrolled 2,770 patients with a single or dual-chamber ICD or cardiac resynchronization defibrillator. Patients were followed for 22±9 months with SVT discriminators on in 96% of patients. Sustained ventricular tachyarrhythmias and SVT episodes were adjudicated by an independent physician committee. For this analysis, all episodes were subjected to post-processing computer simulation with SVT discriminators off with and without delayed high-rate detection criteria (VF zone only, 30/40@320ms). There were 3,282 adjudicated SVT episodes of which 115 resulted in an ICD shock and 113 received only ATP (2-year inappropriate shock and therapy rates of 3.1% and 4.1%). Therapy was appropriately withheld for the remaining 3,054 SVT episodes. With both SVT discriminators and delayed high-rate detection simulated off, the 2-year inappropriate therapy rate would have been 22.9% (Hazard Ratio [HR]=6.24, 95% confidence interval [CI]: 5.20-7.49). With SVT discriminators simulated off and delayed high-rate detection simulated on in all patients, the 2-year rate would have been 6.4% (HR=1.63, CI: 1.44-1.85).
CONCLUSIONS
Use of SVT discriminators has a significant role in reducing the rate of inappropriate ICD therapy even in the setting of delayed high-rate detection settings. Deactivating SVT discriminators would have resulted in an overall increase in the inappropriate ICD therapy rate by 63% and 524% with and without delayed high-rate detection programming, respectively. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:23 October 2019
Deposited On:08 Nov 2019 15:53
Last Modified:08 Nov 2019 15:53
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1045-3873
OA Status:Closed
Publisher DOI:https://doi.org/10.1111/jce.14250
PubMed ID:31646695

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