title: Novel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients: A MADIT-RIT Sub-Study.
abstract: BACKGROUND
  The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT.
  
  
  RESULTS
  The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; P<0.001). High-rate cut-off or delayed ventricular tachycardia therapy programming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; P<0.001 for all). There was a significant reduction in inappropriate anti-tachycardia pacings in both group and a significant reduction in inappropriate ICD shock in CRT-D patients.
  
  
  CONCLUSIONS
  Patients implanted with a CRT-D have lower risk of inappropriate ICD therapy than those with an ICD. Innovative ICD programming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients.
  
  
  BACKGROUND
  http://clinicaltrials.gov; Unique identifier: NCT00947310.
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.). Valentina.Kutyifa@heart.rochester.edu.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Claudio
authors.initials: C
authors.lastname: Schuger
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Helmut
authors.initials: H
authors.lastname: Klein
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Aktas
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.P.D.); Henry Ford Hospital, Detroit, MI (C.S.); Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (M.S.); and Semmelweis University, Heart and Vascular Center, Budapest, Hungary (B.M.).
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D004868:Equipment Failure; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ICD Programming; MADIT-RIT; atrial fibrillation; cardiac resynchronization therapy; implantable cardioverter–defibrillator; supraventricular tachycardia