title: First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry.
abstract: OBJECTIVE
  Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD.
  
  
  RESULTS
  We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm.
  
  
  CONCLUSIONS
  First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming.
authors.affiliation: AP-HP, Hôpital Bichat, Service de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. antoine.leenhardt@bch.aphp.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Leenhardt
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mouton
authors.forename: Marc
authors.initials: M
authors.lastname: Delay
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delarche
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dupuis
authors.forename: Olivier
authors.initials: O
authors.lastname: Bizeau
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.forename: Saida
authors.initials: S
authors.lastname: Cheggour
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
mesh_terms: D000368:Aged; D000465:Algorithms; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*; D012042:Registries; D013617:Tachycardia, Supraventricular / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000628:therapy*; D016896:Treatment Outcome