Counting Down Before Blasting Off

Abstract

Since the first generation of implantable cardioverter-defibrillators (ICDs), technologic advances have markedly enhanced their efficacy and safety and improved the accuracy of arrhythmia detection algorithms. Despite these developments, inappropriate therapies for sinus or supraventricular tachyarrhythmias or lead noise remain a major limitation of contemporary ICDs, with a substantial proportion of patients receiving inappropriate shocks. Psychosocial issues appear to reflect the level of distress related to ICD shocks, with fear of shocks associated with increased anxiety, avoidance behaviors, and perceived functional limitations. 1 Sears Jr., S.E. Conti J.B. Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care. Clin Cardiol. 2003; 26: 107-111 Crossref PubMed Scopus (131) Google Scholar , 2 Irvine J. Dorian P. Baker B. et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J. 2002; 144: 282-289 PubMed Google Scholar , 3 Kuhl E.A. Dixit N.K. Walker R.L. Conti J.B. Sears S.F. Measurement of patient fears about implantable cardioverter defibrillator shock: an initial evaluation of the Florida Shock Anxiety Scale. Pacing Clin Electrophysiol. 2006; 29: 614-618 Crossref PubMed Scopus (83) Google Scholar Although all ICD recipients are potentially at risk, reported rates of inappropriate shocks are particularly high in the young, growing, and complex population with congenital heart disease. 4 Khairy P. Harris L. Landzberg M.J. et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation. 2008; 117: 363-370 Crossref PubMed Scopus (352) Google Scholar , 5 Berul C.I. Van Hare G.F. Kertesz N.J. et al. Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients. J Am Coll Cardiol. 2008; 51: 1685-1691 Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar , 6 Khairy P. Harris L. Landzberg M.J. et al. Sudden death and defibrillators in transposition of the great arteries with intra-atrial baffles: a multicenter study. Circ Arrhythm Electrophysiol. 2008; 1: 250-257 Crossref PubMed Scopus (182) Google Scholar , 7 Khairy P. Defibrillators and cardiac resynchronisation therapy in congenital heart disease. Exp Rev Med Devices. 2008; 5: 267-271 Crossref PubMed Scopus (11) Google Scholar On the basis of the global literature and ICD interrogation in multicenter cohorts with congenital heart disease, it appeared reasonable to speculate that many inappropriate or unnecessary shocks may potentially be averted by tailored programming. This prompted our succinct “Hands On” article offering 10 programming tips in congenital heart disease. 8 Khairy P. Mansour F. Implantable cardioverter-defibrillators in congenital heart disease: 10 programming tips. Heart Rhythm. 2011; 8: 480-483 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar A more detailed general review of ICD programming beyond nominal settings was subsequently proposed. 9 Mansour F. Khairy P. Programming ICDs in the modern era beyond out-of-the box settings. Pacing Clin Electrophysiol. 2011; 34: 506-520 Crossref PubMed Scopus (26) Google Scholar To the Editor—Programming tips and practical programmingHeart RhythmVol. 8Issue 6PreviewI would like to offer two comments on Khairy and Mansour's well-written article on programming of implantable cardioverter-defibrillators (ICDs) in the March 2011 issue of Heart Rhythm.1 Full-Text PDF