title: Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial.
abstract: OBJECTIVE
  Using more intervals to detect ventricular tachyarrhythmias has been associated with reducing unnecessary implantable cardioverter-defibrillator (ICD) therapies.
  
  
  OBJECTIVE
  To determine whether using 30 of 40 intervals to detect ventricular arrhythmias (VT) (long detection) during spontaneous fast VT episodes reduces antitachycardia pacing (ATP) and shock delivery more than 18 of 24 intervals (standard detection).
  
  
  METHODS
  Randomized, single-blind, parallel-group trial that enrolled 1902 primary and secondary prevention patients (mean [SD] age, 65 [11] years; 84% men; 75% primary prevention ICD) with ischemic and nonischemic etiology undergoing first ICD implant at 1 of 94 international centers (March 2008-December 2010).
  
  
  METHODS
  Patients were randomized 1:1 to programming with long- (n = 948) or standard-detection (n = 954) intervals.
  
  
  METHODS
  Total number of ATPs and shocks delivered for all episodes (primary outcomes) and inappropriate shocks, mortality, and syncopal rate (secondary outcomes).
  
  
  RESULTS
  During a median follow-up of 12 months (interquartile range, 11-13), long-detection group had 346 delivered therapies (42 therapies per 100 person-years, 95% CI, 38-47) vs 557 in the standard-detection group (67 therapies per 100 person-years [95% CI, 62-73]; incident rate ratio [IRR], 0.63 [95% CI, 0.51-0.78]; P < .001). The long- vs the standard-detection group experienced 23 ATPs per 100 person-years (95% CI, 20-27) vs 37 ATPs per 100 person-years (95% CI, 33-41; IRR, 0.58 [95% CI, 0.47-0.72]; P < .001); 19 shocks per 100 person-years (95% CI, 16-22) vs 30 shocks per 100 person-years (95% CI, 26-34; IRR, 0.77 [95% CI, 0.59-1.01]; P = .06), with a significant difference in the probability of therapy occurrence (P < .001); and a reduction in first occurrence of inappropriate shock (5.1 per 100 patient-years [95% CI, 3.7-6.9] vs 11.6 [95% CI, 9.4-14.1]; IRR, 0.55 [95% CI, 0.36-0.85]; P = .008). Mortality (5.5 [95% CI, 4.0-7.2] vs 6.3 [95% CI, 4.8-8.2] per 100 patient-years; HR, 0.87; P = .50) and arrhythmic syncope rates (3.1 [95% CI, 2.6-4.6] vs 1.9 [95% CI, 1.1-3.1] per 100 patient-years; IRR, 1.60 [95% CI, 0.76-3.41]; P = .22) did not differ significantly between groups.
  
  
  CONCLUSIONS
  Among patients receiving an ICD, the use of a long- vs standard-detection interval resulted in a lower rate of ATP and shocks, and inappropriate shocks. This programming strategy may be an appropriate alternative.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00617175.
authors: Electrophysiology and Pacing Unit, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (MI), Italy. maurizio.gasparini@humanitas.it
authors: Maurizio
authors: M
authors: Gasparini
authors: Alessandro
authors: A
authors: Proclemer
authors: Catherine
authors: C
authors: Klersy
authors: Axel
authors: A
authors: Kloppe
authors: Maurizio
authors: M
authors: Lunati
authors: José Bautista Martìnez
authors: JB
authors: Ferrer
authors: Ahmad
authors: A
authors: Hersi
authors: Marcin
authors: M
authors: Gulaj
authors: Maurits C E F
authors: MC
authors: Wijfels
authors: Elisabetta
authors: E
authors: Santi
authors: Laura
authors: L
authors: Manotta
authors: Angel
authors: A
authors: Arenal
mesh_terms: D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D011322:Primary Prevention; D011788:Quality of Life; D055502:Secondary Prevention; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome