Letter to the Editor: ICD programming

Abstract

To the editor of the Indian heart journal, With great interest I have read the article from Mauro Biffi about ICD programming (Biffi M. ICD programming. Indian Heart J. 2014 January–February; 66S1:S88–S100). I'm delighted that finally there is a current review on this subject published. I have just some comments on this review: 1) In the present review, the author mentioned the MADIT-RIT trial as following “Indeed, whereas inappropriate shock delivery was significantly reduced in both the RELEVANT and in the ADVANCE III study, no effect was observed in the MADIT-RIT trial, possibly owing to the absence of SVT discriminators in the VF zone in Boston Scientific devices. Indeed, inappropriate ATP delivery on AF or SVTs inducing VT/VF was hypothesized as a possible explanation of ATP being associated with increased mortality in the MADIT-RIT trial8,9”. The author might have mixed up the existing letters to the editor in the N Engl J Med about the MADIT-RIT trial (see author's reference 9) since not “Kay GN, Ellenbogen KA. A clinical trial of ICD programming. N Engl J Med. 2013 Mar 7; 368(10):965” but “Reif S, Antoni D, Hoffmann E. A clinical trial of ICD programming. N Engl J Med. 2013 Mar 7; 368(10):964” have discussed the subject “inappropriate ATP delivery on AF or SVTs inducing VT/VF was hypothesized as a possible explanation of ATP being associated with increased mortality in the MADIT-RIT trial”. This should be adapted in the final version of this review. 2) Why doesn't the author enable SMART Mode in Medtronic devices or equivalent ATP optimization features in other devices (Fig. 3)? Is there any disadvantage to be considered for the author? A short discussion about this would be interesting. 3) The author states in the paragraph on SVT discrimination that “Arrhythmia discrimination is applied at VT detection (VF also for Medtronic and NayaMed), whereas it is not applied during re-detection (after the first therapy has been delivered) apart from Medtronic, NayaMed, and Boston Scientific, that can apply “stability” during re-detection. “I agree with the fact that “stability” is the only optional feature for re-detection in Medtronic devices with concomitant limitation in SVT specificity. Therefore, I was wondering why the author has disabled the “stability” feature in Fig. 2. Would the author recommend to disable this feature for re-detection? 4) In contrast to the author's statement from above, there are in fact devices e.g. from Sorin and Biotronik, respectively where dual chamber SVT discrimination algorithms (PARAD+ and SMART, respectively) work not only during detection but also during re-detection. This might have an impact on SVT discrimination and the rate of inappropriate ICD therapy and should be taken into account. I am interested in your opinion on these remarks. Thanks very much in anticipation of your work and cooperation, and I look forward to hearing from you soon.