Improving implantable cardioverter defibrillator therapy through better programming

Abstract

Implantable cardioverter defibrillator (ICD) therapy is a highly efficient, nonpharmacological treatment option that delivers rapid pacing stimuli, antitachycardia pacing (ATP) or shock to reduce death linked to the development of ventricular tachycardia (VT) or ventricular fibrillation among patients at high-risk for ventricular arrhythmias [1–3]. Despite the significant mortality benefit of ICDs, a high incidence (11.5–17.4%) of inappropriate device activation has been reported owing to supraventricular arrhythmias and atrial fibrillation [4,5]. As presented in a substudy of the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT-II), inappropriate ICD therapy predominantly occurs in the 170–190 bpm heart rate range [4]. Inappropriate ICD therapies are associated with impaired quality of life [6] and adverse clinical outcome [7,8]. Some studies suggested an increased mortality with inappropriate ICD activation in this patient population [4,7,8].