Piccini JP, et al. - Researchers performed a nationwide assessment of ICD/CRT-D patients with linked remote monitoring data in order to assess the efficacy of programming strategies for attenuating shocks and mortality. Findings demonstrated an association of rate programming with lower risk of shocks or death compared with delayed detection. In patients programmed with both high rate and delayed detection, optimal outcomes were observed.

Methods

• Researchers classified patients based upon the presence or absence of high rate detection and delayed detection: higher rate delayed detection (HRDD), higher rate early detection (HRED), lower rate delayed detection (LRDD), and lower rate early detection (LRED).
• They used Cox-regression to compare mortality and shock-free survival.

Results

• This study included 64,769 patients (age 68±12 years; 27% female; 46% CRT-D; follow-up 1.7±1.1 years).
• Findings revealed that in the first year, 13% of HRDD, 14% of HRED, 18% of LRDD, and 20% in the LRED group experienced a shock.
• Researchers observed that after adjustment, HRDD was associated with lower risk of shock than HRED (HR 0.93 [95% CI 0.89-0.98], p=0.002), LRDD (HR 0.63 [95% CI 0.60-0.66], p<0.001), and LRED (HR 0.58 [95% CI 0.55-0.61], p<0.001).
• Data also reported that HRDD was associated with lower risk of mortality than HRED (adjusted HR 0.80 [95% CI 0.75-0.86], p<0.001), LRDD (HR 0.76 [95% CI 0.70-0.83], p<0.001), and LRED (HR 0.68 [95% CI 0.62-0.73], p<0.001).
• In addition, researchers found similar results in patients with or without a shock in the first 6 months after implant.