Author + information
- Received April 3, 2017
- Revision received April 26, 2017
- Accepted May 1, 2017
- Published online May 11, 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, PhD.l
- aHumanitas Research Hospital IRRCCS, Rozzano, Milano, Italy
- bAzienda Ospedaliera Niguarda Ca' Granda, Piazza Ospedale Maggiore, Milano, 3 - 20162, Italy
- cAzienda Ospedaliero Universitaria S. Maria della Misericordia, p.zza S, Maria della Misericordia, Udine, 33100, Italy
- dHospital Gregorio Maranon, Madrid, Spain
- eCardiology and Angiology, Luedenscheid, Germany
- fHospital de Txagorritxu C/ José Achotegui, Vitoria, Spain
- gKing Saud University, Riyadh, Saudi Arabia
- hMSWiA Hospital, Bialystok, Poland
- iSt. Antonius Ziekenhuis Hospital, P.O. Box 2500, EM Nieuwegein, 3430, The Netherlands
- jMedtronic, Rome, Italy
- kMedtronic, Milan, Italy
- lCleveland Clinic Cardiovascular Medicine, Cleveland, OH, USA
- ↵∗Corresponding Author: Dr. Maurizio Gasparini Chief of Electrophysiology and Pacing Unit, Humanitas Research Hospital, IRRCCS Via Manzoni 56, 20089 Rozzano (MI), Italy Phone: ++39/02-82244622; ++39/02-82247450; Fax: ++39/02-82244693.
Background Programming strategies may reduce unnecessary implantable cardioverter defibrillator (ICD) shocks and their adverse effects but to date have been described only for dual chamber ICDs.
Objective We aimed to evaluate the effects of programming a long detection in single chamber (VVI) ICDs in the multicenter prospective ADVANCEIII trial.
Methods 545 subjects (85% male, atrial fibrillation (AF) 25%, LVEF 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving VVI ICDs were randomized to Long Detection (30/40 intervals) or Standard Programming (18/24) based on device type, AF history and indication. In both arms, anti-tachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320-200 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 267 patients were randomized to long detection and 278 to control group. Median follow up was 12 months. 112 therapies (shocks and ATP) occurred in long detection vs 257 in the control arm, ie a 48% reduction with 30/40 (95%CI: 0.36-0.76, p=0.002). In the long detection vs control, overall shocks were reduced by 40% (48 vs 24, 95%CI: 0.38-0.94, p=0.026) and appropriate shocks by 51% (34 vs 74, 95%CI: 0.26-0.94, p=0.033). Syncopes did not differ between arms but survival improved in the long detection.
Conclusion Among patients implanted with VVI ICDs programming long detection significantly reduced appropriate therapies, shocks and all-cause mortality.
Disclosures: E. Santi, L. Manotta are employees of Medtronic, Inc. N. Varma: Research grant from Medtronic Inc. All other authors have nothing to disclose.
Funding: The ADVANCEIII Study was supported financially by Medtronic, Inc. Minneapolis, Minn. Medtronic participated in the design, conduct, management of the study and had no role in the collection of data; Medtronic participated to review and approval of the manuscript and had no role in the interpretation of data.
- Received April 3, 2017.
- Revision received April 26, 2017.
- Accepted May 1, 2017.