Very high rate programming in primary prevention patients with reduced ejection fraction implanted with a defibrillator: Results from a large multicenter controlled study.
BACKGROUND
Programming implantable cardioverter-defibrillators (ICDs) with a high-rate therapy strategy has proven to be effective in reducing shocks and is associated with a reduced mortality.


OBJECTIVE
We sought to determine the impact of a very high rate cutoff programming strategy on outcomes in patients with a primary indication for an ICD due to reduced left ventricular ejection fraction.


METHODS
Using data from the multicenter French DAI-PP registry, this cohort-controlled study compared outcomes in 500 patients programmed with a very high rate cutoff (VH-RATE group: monitor zone 170-219 beats/min; ventricular fibrillation zone ≥220 beats/min with 13 ± 4 detection intervals) with 1500 matched control patients programmed with 1 or 2 therapy zone. All ICDs were implanted for primary prevention in patients with systolic dysfunction. Risks of events were compared after propensity score matching of sex, age, ejection fraction, New York Heart Association class, cardiomyopathy, atrial fibrillation, and type of device.


RESULTS
After a mean follow-up of 3.6 ± 2.3 years, VH-RATE programming was associated with a reduction of appropriate therapy risk (hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.31-0.51; P < .0001) and inappropriate shock (HR 0.42; 95% CI 0.27-0.63; P < .0001). It was also associated with a decreased risk of sudden cardiac death (HR 0.43; 95% CI 0.17-0.99; P = .04) as compared with patients programmed with 2 therapy zones. There was no significant difference in overall survival between the groups.


CONCLUSION
In patients implanted with an ICD in primary prevention with left ventricular dysfunction, very high rate cutoff programming (single therapy zone ≥220 beats/min) was associated with a 60% reduction of appropriate therapies as well as inappropriate shocks, without affecting mortality.
['Clementy|Nicolas|N|', 'Challal|Farid|F|', 'Marijon|Eloi|E|', 'Boveda|Serge|S|', 'Defaye|Pascal|P|', 'Leclercq|Christophe|C|', 'Deharo|Jean-Claude|JC|', 'Sadoul|Nicolas|N|', 'Klug|Didier|D|', 'Piot|Olivier|O|', 'Gras|Daniel|D|', 'Bordachar|Pierre|P|', 'Algalarrondo|Vincent|V|', 'Fauchier|Laurent|L|', 'Babuty|Dominique|D|', '|||']
D000368:Aged D015331:Cohort Studies D016757:Death, Sudden, Cardiac D017147:Defibrillators, Implantable D004554:Electric Countershock D005260:Female D005500:Follow-Up Studies D005602:France D006339:Heart Rate D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D010043:Outcome and Process Assessment, Health Care D011322:Primary Prevention D016016:Proportional Hazards Models D012307:Risk Factors D013318:Stroke Volume D017180:Tachycardia, Ventricular D018487:Ventricular Dysfunction, Left
High rate Programming Primary prevention Implantable cardioverter-defibrillator Shock Outcome Appropriate Inappropriate Sudden cardiac death Antitachycardia pacing