Background

Recent evidence has revealed the utility of prolonged arrhythmia detection duration and increased rate cutoff to reduce implantable cardioverter-defibrillator (ICD) therapies. Data on real-world trends in ICD programming and its impact on outcomes are limited.

Objective

The purpose of this study was to evaluate trends in ICD programming and its impact on ICD therapy using a large remote monitoring database.

Methods

A retrospective analysis of patients with ICD implanted from 2007 to 2018 was conducted using the de-identified Medtronic CareLink database. Data on ICD programming (number of intervals to detection [NID] and therapy rate cutoff) and delivered ICD therapies were collected.

Results

Among 210,810 patients, the proportion programmed to a rate cutoff of ≥188 beats/min increased from 41% to 49% and an NID of ≥30/40 increased from 17% to 67% before May 2013 vs after February 2016. Programming to a rate cutoff of ≥188 beats/min, a ventricular fibrillation (VF) NID of ≥30/40, or a combined rate cutoff of ≥188 beats/min and VF NID of ≥30/40 were associated with reductions in ICD therapy. The largest reductions in ICD therapy occurred when the combination of rate cutoff ≥ 188 beats/min and VF NID ≥ 30/40 was programmed (antitachycardia pacing: hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.34–0.36; P < .001; shocks: HR 0.67; 95% CI 0.65–0.69; P < .001; and antitachycardia pacing/shocks: HR 0.43; 95% CI 0.42–0.44; P < .001).

Conclusion

Despite evidence supporting the use of prolonged detection duration and high rate cutoff, implementation of shock reduction programming strategies in real-world clinical practice has been modest. The use of evidence-based ICD programming is associated with reduced ICD shocks over long-term follow-up.

中文翻译：

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植入式心脏复律除颤器编程实践的趋势及其对治疗的影响：来自 2007-2018 年北美远程监测登记处的见解

背景

最近的证据表明，延长心律失常检测持续时间和增加频率截止值可减少植入式心脏复律除颤器 (ICD) 治疗。ICD 规划的实际趋势及其对结果的影响的数据有限。

客观的

本研究的目的是使用大型远程监控数据库评估 ICD 编程的趋势及其对 ICD 治疗的影响。

方法

使用去识别的 Medtronic CareLink 数据库对 2007 年至 2018 年植入 ICD 的患者进行了回顾性分析。收集有关 ICD 编程（检测间隔数 [NID] 和治疗率截止值）和提供的 ICD 治疗的数据。

结果

在 210,810 名患者中，2013 年 5 月之前与 2016 年 2 月之后相比，编程为 ≥188 次/分钟的心率截止值的比例从 41% 增加到 49%，并且 NID ≥30/40 从 17% 增加到 67%。 ≥188 次/分钟的心率截止值、≥30/40 的心室颤动 (VF) NID 或 ≥188 次/分钟的心率截止值和 ≥30/40 的 VF NID 与 ICD 治疗的减少有关。ICD 治疗的最大减少发生在设定心率截止 ≥ 188 次/分钟和 VF NID ≥ 30/40 的组合时（抗心动过速起搏：风险比 [HR] 0.35；95% 置信区间 [CI] 0.34–0.36；P  < .001；电击：HR 0.67；95% CI 0.65–0.69；P < .001；抗心动过速起搏/电击：HR 0.43；95% CI 0.42–0.44；P < .001）。

结论

尽管有证据支持使用延长的检测持续时间和高速率截止，但在现实世界的临床实践中实施减少电击的编程策略一直是适度的。使用基于证据的 ICD 编程与长期随访中减少 ICD 冲击有关。