Impact of the introduction of a standardised ICD programming protocol: real-world data from a single centre.
OBJECTIVE
Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a "real-world" setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming protocol in a real-world setting of unselected ICD recipients.


METHODS
We analysed 270 consecutive ICD recipients implanted in a single centre-135 implanted prior to protocol implementation (physician-led group) and 135 after (standardised group). The protocol included long arrhythmia detection times (30/40 or equivalent) and high rate detection zones (primary prevention lower treatment zone 200 bpm). Programming in the physician-led group was at the discretion of the implanter. The primary endpoint was time-to-any therapy (ATP or shocks). Secondary endpoints were time-to-inappropriate therapy and time-to-appropriate therapy. The safety endpoints were syncopal episodes, hospital admissions and death.


RESULTS
At 12 months follow-up, 47 patients had received any ICD therapy (physician-led group, n = 31 vs. standardised group, n = 16). There was a 47 % risk reduction in any device therapy (p = 0.04) and an 86 % risk reduction in inappropriate therapy (p = 0.009) in the standardised compared to the physician-led group. There was a non-significant 30 % risk reduction in appropriate therapy (p = 0.32). Results were consistent across primary and secondary prevention patients. There were no significant differences in the rates of syncope, hospitalisation, and death.


CONCLUSIONS
In unselected patients in a real-world setting, introduction of a standardised programming protocol, using long detection times and high detection zones, significantly reduces the burden of ICD therapy without an increase in adverse outcomes.
King's College Hospital, Denmark Hill, London, UK.
Nicholas
N
Sunderland
King's College Hospital, Denmark Hill, London, UK.
Amit
A
Kaura
King's College Hospital, Denmark Hill, London, UK.
Anthony
A
Li
King's College Hospital, Denmark Hill, London, UK.
Ravi
R
Kamdar
King's College Hospital, Denmark Hill, London, UK.
Ed
E
Petzer
King's College Hospital, Denmark Hill, London, UK.
Para
P
Dhillon
King's College Hospital, Denmark Hill, London, UK.
Francis
F
Murgatroyd
King's College Hospital, Denmark Hill, London, UK. paulscott3@nhs.net.
Paul A
PA
Scott
D000368:Aged; D015984:Causality; D017147:Defibrillators, Implantable / Q000592:standards* / Q000706:statistics & numerical data*; D003936:Diagnosis, Computer-Assisted / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D004556:Electric Injuries / Q000401:mortality / Q000517:prevention & control; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013813:Therapy, Computer-Assisted / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
High detection rate; Implantable cardioverter defibrillator; Inappropriate therapy; Long detection time; Shocks