The effect of ICD programming on inappropriate and appropriate ICD Therapies in ischemic and nonischemic cardiomyopathy: the MADIT-RIT trial.

Abstract

INTRODUCTION:

The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy.

METHODS AND RESULTS:

First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic cardiomyopathy. Patients with ischemic and nonischemic cardiomyopathy had similar incidence of first inappropriate (9% and 11%, P = 0.21) and first appropriate ICD therapy (11.6% and 14.1%, P = 0.15). Patients with ischemic cardiomyopathy had higher mortality rate (6.1% vs. 3.3%, P = 0.01). MADIT-RIT high-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P < 0.001 for all comparisons). Occurrence of total inappropriate and appropriate ICD therapies was significantly reduced by high-rate cut-off ICD programming and delayed VT therapy ICD programming in both ischemic and nonischemic cardiomyopathy patients.

CONCLUSION:

High-rate cut-off and delayed VT therapy ICD programming are associated with significant reduction in first and total inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy.

• Authors: Kamil Sedláček, Anne-Christine Ruwald, Valentina Kutyifa, Scott McNitt, Poul Erik Bloch Thomsen, Helmut Klein, Martin Stockburger, Dan Wichterle, Bela Merkely, Joaquin Fernandez DE LA Concha, Moshe Swissa, Wojciech Zareba, Arthur J Moss, Josef Kautzner, Martin H Ruwald, MADIT-RIT Investigators
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 26 Issue 4 Pg. 424-433 (Apr 2015) ISSN: 1540-8167 [Electronic] United States
• PMID: 25546486 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Wiley Periodicals, Inc.

Topics

• Aged
• Cardiomyopathies (diagnosis, etiology, mortality, physiopathology)
• Chi-Square Distribution
• Death, Sudden, Cardiac (etiology, prevention & control)
• Defibrillators, Implantable
• Electric Countershock (adverse effects, instrumentation, mortality)
• Electrophysiologic Techniques, Cardiac
• Equipment Design
• Equipment Failure
• Europe
• Female
• Humans
• Israel
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Ischemia (complications, diagnosis, mortality)
• Predictive Value of Tests
• Proportional Hazards Models
• Risk Factors
• Signal Processing, Computer-Assisted
• Tachycardia, Ventricular (diagnosis, etiology, mortality, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• United States