Long-Detection Programming in Single-Chamber Implantable Cardioverter Defibrillators Reduces Shocks and Pacing

Long-detection programming improved survival, decreased the likelihood of hospitalization, and reduced therapy in patients with single-chamber ICDs.

Patients with single-chamber implantable cardioverter defibrillators (ICDs) benefitted from long-detection programming, according to a study subanalysis published in JACC: Clinical Electrophysiology.1

Previously, the results of the ADVANCE III trial (Effect of Long-Detection vs Standard-Detection Interval for Implantable Cardioverter-Defibrillators on Antitachycardia Pacing and Shock Delivery; ClinicalTrials.gov identifier: NCT00617175) demonstrated that extending the duration of monitoring prior to therapy initiation reduced ICD therapies by 37% compared with conventional programming in patients with single-chamber ICDs, dual-chamber ICDs, and cardiac resynchronization therapy ICDs.2

In the current subanalysis, the researchers sought to evaluate this programming technique only in patients with single-chamber ICDs.

Of the ADVANCE III study cohort, 545 patients received single-chamber ICDs; 267 patients were randomly assigned to long-detection and 278 to a control group. Patients were followed for a median of 12 months. In the long-detection group, a total of 112 therapies (shocks and antitachycardia pacing) were used compared with 257 therapies in the control group.

Overall shocks were reduced by 40% in the long-detection arm (48 vs 24; 95% CI, 0.38-0.94; P =.026), and appropriate shocks by 51% (34 vs 74; 95% CI, 0.26-0.94; P =.033). In addition, patients in the long-detection group had a 27% probability of being hospitalized for any cause at 1 year compared with 36% in the control group (P =.04).

Although syncope was rare in both groups, long-detection improved survival rates. During follow-up, 8 patients in the long-detection group died vs 20 patients in the control group, which the researchers determined meant intervention was associated with a 59% reduction in mortality (hazard ratio 0.41; 95% CI, 0.17-0.99; P =.047).

Larger randomized trials with patients who have single-chamber ICDs are necessary to confirm the relationship between long-detection programming and mortality in this population, the researchers concluded.

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  1. Gasparini M, Lunati MG, Proclemer A, et al. Long detection programming in single chamber defibrillators reduces unnecessary therapies and mortality: the ADVANCE III trial [published online May 11, 2017]. JACC Clin Electrophisolol. doi:10.1016/j.jacep.2017.05.001
  2. Gasparini M, Proclemer A, Klersy C, et al. Effect of long-detection vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery — the ADVANCE III randomized clinical trial. JAMA. 2013;309:1903-1911.