Very high rate programming in primary prevention patients with reduced ejection fraction implanted with a defibrillator: Results from a large multicenter controlled study

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• 作者：Nicolas Clementy ; MD^* ; ^{nclementy@yahoo.fr} ; Farid Challal ; MD^* ; Eloi Marijon ; MD ; PhD^&dagger ; ; Serge Boveda ; MD^&Dagger ; ; Pascal Defaye ; MD^§ ; ; Christophe Leclercq ; MD ; PhD^║ ; Jean-Claude Deharo ; MD ; PhD^¶ ; ; Nicolas Sadoul ; MD ; PhD^# ; Didier Klug ; MD ; PhD^** ; Olivier Piot ; MD^&dagger ; &dagger ; ; Daniel Gras ; MD^&Dagger ; &Dagger ; ; Pierre Bordachar ; MD ; PhD^§ ; § ; ; Vincent Algalarrondo ; MD ; PhD^║║ ; Laurent Fauchier ; MD ; PhD^* ; Dominique Babuty ; MD ; PhD^* ; DAI-PP Investigators
• 关键词：Implantable cardioverter-defibrillator ; Primary prevention ; Sudden cardiac death ; High rate ; Programming ; Appropriate ; Inappropriate ; Antitachycardia pacing ; Shock ; Outcome
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：14
• 期：2
• 页码：211-217
• 全文大小：265 K
• 卷排序：14

文摘

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.ObjectiveWe 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.MethodsUsing 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.ResultsAfter 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.ConclusionIn 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.