title: Very high rate programming in primary prevention patients with reduced ejection fraction implanted with a defibrillator: Results from a large multicenter controlled study.
abstract: Programming implantable cardioverter-defibrillators (ICDs) with a high-rate therapy strategy has proven to be effective in reducing shocks and is associated with a reduced mortality.
  
  
  
  We sought to determine the impact of a very high rate cutoff programming strategy on outcomes in patients with a primary indication for an ICD due to reduced left ventricular ejection fraction.
  
  
  
  Using data from the multicenter French DAI-PP registry, this cohort-controlled study compared outcomes in 500 patients programmed with a very high rate cutoff (VH-RATE group: monitor zone 170-219 beats/min; ventricular fibrillation zone ≥220 beats/min with 13 ± 4 detection intervals) with 1500 matched control patients programmed with 1 or 2 therapy zone. All ICDs were implanted for primary prevention in patients with systolic dysfunction. Risks of events were compared after propensity score matching of sex, age, ejection fraction, New York Heart Association class, cardiomyopathy, atrial fibrillation, and type of device.
  
  
  
  After a mean follow-up of 3.6 ± 2.3 years, VH-RATE programming was associated with a reduction of appropriate therapy risk (hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.31-0.51; P < .0001) and inappropriate shock (HR 0.42; 95% CI 0.27-0.63; P < .0001). It was also associated with a decreased risk of sudden cardiac death (HR 0.43; 95% CI 0.17-0.99; P = .04) as compared with patients programmed with 2 therapy zones. There was no significant difference in overall survival between the groups.
  
  
  
  In patients implanted with an ICD in primary prevention with left ventricular dysfunction, very high rate cutoff programming (single therapy zone ≥220 beats/min) was associated with a 60% reduction of appropriate therapies as well as inappropriate shocks, without affecting mortality.
authors.affiliation: CHU Trousseau, François Rabelais University, Tours, France. Electronic address: nclementy@yahoo.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Clementy
authors.affiliation: CHU Trousseau, François Rabelais University, Tours, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Challal
authors.affiliation: European Georges Pompidou Hospital, Paris Descartes University, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: CHU Michallon, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: CHU Pontchaillou, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: CHU La Timone, Marseille, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.affiliation: CHU Brabois, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: CHRU Lille, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Clinique Cardiologique du Nord, Saint Denis, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Piot
authors.affiliation: Nouvelles Cliniques Nantaises, Nantes, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.affiliation: CHU Haut Lévêque, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: CHU Antoine Béclère, Clamart, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Algalarrondo
authors.affiliation: CHU Trousseau, François Rabelais University, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: CHU Trousseau, François Rabelais University, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011322:Primary Prevention / Q000379:methods; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000150:complications / Q000401:mortality / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology
keywords: Antitachycardia pacing; Appropriate; High rate; Implantable cardioverter-defibrillator; Inappropriate; Outcome; Primary prevention; Programming; Shock; Sudden cardiac death