title: Relationship between age and inappropriate implantable cardioverter-defibrillator therapy in MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy).
abstract: BACKGROUND
  There is limited data regarding the relationship between age and inappropriate therapy among patients with an implantable cardioverter-defibrillator (ICD) and resynchronization therapy.
  
  
  OBJECTIVE
  We aimed to investigate this relationship and the effect of ICD programming on inappropriate therapy by age.
  
  
  METHODS
  In the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) 1500 patients were randomized to 3 ICD programming arms: (A) conventional with ventricular tachycardia (VT) therapy ≥170; (B) high-rate cutoff with VT therapy ≥200, and (C) prolonged 60-second delay for VT therapy ≥170. We investigated the relationship between age, the risk of inappropriate ICD therapy (including antitachycardia pacing [ATP] or shock), and ICD programming.
  
  
  RESULTS
  Cumulative incidence function Kaplan-Meier graphs showed an inverse relationship between increasing quartiles of age (Q1: ≤55, Q2: 56-64, Q3: 65-71, and Q4: ≥72 years) and the risk for inappropriate therapy. Multivariate analyses showed that each increasing decade of life was associated with 34% (P < .001), 27% (P < .001), and 26% (P < .001) reduction in the risk of inappropriate shock, inappropriate ATP, and any inappropriate therapy, respectively. Treatment arms B and C as compared with arm A were associated with a significant reduction in the risk of inappropriate therapies across all age quartiles (P < .001 for all).
  
  
  CONCLUSIONS
  Among patients with a primary prevention indication for an ICD, there is an inverse relationship between age and inappropriate ICD therapy. Innovative ICD programming of high-rate cutoff or prolonged delay for VT therapy is associated with significant reductions in inappropriate therapy among all age groups.
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York; Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,. Electronic address: yitschak.biton@heart.rochester.edu.
authors.forename: Yitschak
authors.initials: Y
authors.lastname: Biton
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York; Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York; Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York.
authors.forename: Spencer
authors.initials: S
authors.lastname: Rosero
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Cardiology Department(,) Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Strasberg
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Heart Research Follow(-)up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, Rochester, New York; Cardiology Department(,) Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
mesh_terms: D000367:Age Factors; D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Age; Cardiac resynchronization therapy with defibrillator; Implantable cardioverter-defibrillator; Inappropriate ICD therapy; Supra ventricular arrhythmia