Author + information
- Received April 3, 2017
- Revision received April 26, 2017
- Accepted May 1, 2017
- Published online November 20, 2017.
- Maurizio Gasparini, MDa,∗ (, )
- Maurizio G. Lunati, MDb,
- Alessandro Proclemer, MDc,
- Angel Arenal, MDd,
- Axel Kloppe, MDe,
- Josè B. Martínez Ferrer, MDf,
- Ahmad S. Hersi, MDg,
- Marcin Gulaj, MDh,
- Maurits C.E. Wijffels, MDi,
- Elisabetta Santi, MSj,
- Laura Manotta, MSk and
- Niraj Varma, MD, PhDl
- aHumanitas Research Hospital IRRCCS, Rozzano Milan, Italy
- bAzienda Ospedaliera Niguarda Ca' Granda, Milan, Italy
- cAzienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
- dHospital Gregorio Maranon, Madrid, Spain
- eMedizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität-Bochum, Bochum, Germany
- fHospital de Txagorritxu C/ José Achotegui, Vitoria, Spain
- gKing Saud University, Riyadh, Saudi Arabia
- hMSWiA Hospital, Bialystok, Poland
- iSt. Antonius Ziekenhuis Hospital, Nieuwegein, the Netherlands
- jMedtronic, Rome, Italy
- kMedtronic, Milan, Italy
- lCleveland Clinic Cardiovascular Medicine, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Maurizio Gasparini, Electrophysiology and Pacing Unit, Humanitas Research Hospital, IRRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy.
Objectives This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial.
Background Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs.
Methods A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length <200 ms. Wavelet and stability functions enabled. Therapies delivered were compared using a negative binomial regression model.
Results A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm.
Conclusions Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175)
The ADVANCE III Study was supported financially by Medtronic, Inc. Medtronic participated in the design, conduct, and management of the study and had no role in the collection of data. Medtronic participated in the review and approval of the manuscript and had no role in the interpretation of data. Dr. Lunati has received research grants and honoraria from Medtronic, Inc. Dr. Varma has received research grants, consultant fees, and advisory board fees from Medtronic, Inc. Dr. Kloppe has received study grants and reimbursements for lecture fees. E. Santi and L. Manotta are employees of Medtronic, Inc. All other authors have reported that they have no relationships relevant to this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 3, 2017.
- Revision received April 26, 2017.
- Accepted May 1, 2017.
- 2017 The Authors