Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: A MADIT-RIT sub-study

Valentina Kutyifa, James P. Daubert, Claudio Schuger, Ilan Goldenberg, Helmut Klein, Mehmet K. Aktas, Scott McNitt, Martin Stockburger, Bela Merkely, Wojciech Zareba, Arthur J. Moss

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background-The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT. Methods and Results-The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; P<0.001). High-rate cut-off or delayed ventricular tachycardia therapy programming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; P<0.001 for all). There was a significant reduction in inappropriate anti-tachycardia pacings in both group and a significant reduction in inappropriate ICD shock in CRT-D patients. Conclusions-Patients implanted with a CRT-D have lower risk of inappropriate ICD therapy than those with an ICD. Innovative ICD programming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients. Clinical Trial Registration-http://clinicaltrials.gov; Unique identifier: NCT00947310.

Original languageEnglish
Article numbere001965
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Keywords

  • Atrial fibrillation
  • Cardiac resynchronization therapy
  • ICD Programming
  • Implantable cardioverter-defibrillator
  • MADIT-RIT
  • supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Kutyifa, V., Daubert, J. P., Schuger, C., Goldenberg, I., Klein, H., Aktas, M. K., McNitt, S., Stockburger, M., Merkely, B., Zareba, W., & Moss, A. J. (2016). Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: A MADIT-RIT sub-study. Circulation: Arrhythmia and Electrophysiology, 9(1), [e001965]. https://doi.org/10.1161/CIRCEP.114.001965