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Published in: Clinical Research in Cardiology 12/2015

01-12-2015 | Original Paper

Reduction of inappropriate ICD therapies in patients with primary prevention of sudden cardiac death: DECREASE study

Authors: Jörg Otto Schwab, Hendrik Bonnemeier, Thomas Kleemann, Johannes Brachmann, Sven Fischer, Frank Birkenhauer, Frank Eberhardt

Published in: Clinical Research in Cardiology | Issue 12/2015

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Abstract

Background

A significant number of patients with an implantable cardioverter/defibrillator (ICD) for primary prevention receive inappropriate shocks. Previous studies have reported a reduction of inappropriate therapies with simple modifications of ICD detection settings, however, inclusion criteria and settings varied markedly between studies. Our aim was to investigate the effect of raising the ICD detection zone in the entire primary prevention ICD population.

Methods and results

543 patients receiving an ICD for primary prevention were randomized to either conventional or progressive ICD programming. The detection rate was programmed at 171 bpm for ventricular tachycardia (VT) and 214 bpm for ventricular fibrillation (VF) in the Conventional group and 187 bpm for VT and 240 bpm for VF in the Progressive group. 43 % of patients received single-chamber and 57 % dual-chamber detection devices (DDD-ICD 19 %; CRT-D 38 %). The primary endpoint consisted of inappropriate therapies and untreated VT/VF. The primary endpoint was reached in 35 patients (13 %) in the Conventional group and 17 patients (6 %) in the Progressive group (p = 0.004). Progressive ICD programming led to significantly fewer amount of patients with ICD therapies (26 vs. 14 %; p < 0.001) and shocks (11 vs. 5 %; p = 0.023) compared to conventional ICD programming. Sub-analyses showed the greatest reduction of inappropriate therapies and shocks in dual-chamber detection devices with progressive compared to single-chamber detection devices with conventional ICD programming (p < 0.001).

Conclusions

Progressive ICD programming reduces the number of inappropriate therapies and shocks in a broad primary prevention ICD population particularly in combination with dual-chamber detection algorithms.

Clinical trial registration

http://​clinicaltrials.​gov; ClinicalTrials.gov identifier NCT01217528.
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Metadata
Title
Reduction of inappropriate ICD therapies in patients with primary prevention of sudden cardiac death: DECREASE study
Authors
Jörg Otto Schwab
Hendrik Bonnemeier
Thomas Kleemann
Johannes Brachmann
Sven Fischer
Frank Birkenhauer
Frank Eberhardt
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 12/2015
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-015-0870-z

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