Effect of Novel Programming on Inappropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Very Low Ejection Fraction (from A MADIT-RIT).

Journal Article (Journal Article;Multicenter Study)

The Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy showed a significant reduction in the risk of inappropriate therapy in patients with a programmed high-rate cutoff ≥200 beats per minute or delayed therapy for events ≥170 beats per minute compared with conventional programming. We aimed to characterize outcomes by left ventricular ejection fraction (LVEF) ranges for patients with high-rate, delayed, or conventional implantable cardioverter-defibrillator programming. We assessed the effect of LVEF (LVEF <15%, LVEF 15% to 25%, LVEF >25%) on the risk of inappropriate conventional implantable cardioverter-defibrillator therapy and death in Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy. Inappropriate therapies and death were independently evaluated by the adjudication committee. Statistical methods involved Kaplan-Meier time-to-event graphs and Cox proportional hazards regression analyses. The study involved 140 patients (9%) with LVEF 15%, 585 with LVEF 15% to 25% (39%), and 774 with LVEF >25% (52%). High-rate or delayed programming significantly reduced the risk of inappropriate therapy compared with conventional programming in patients with all LVEFs (p <0.001 for all LVEF). Patients with LVEF <15% had an exceptional 97% lower risk of inappropriate therapy, with high-rate programming than conventional programming (hazard ratio 0.028, p = 0.001), without an increase in mortality. High-rate and delayed programming is superior to conventional programming in all LVEF ranges, without adverse effects.

Full Text

Duke Authors

Cited Authors

  • Jawaid, A; Chokshi, M; Zareba, W; Schuger, C; Daubert, J; McNitt, S; Singh, J; Goldenberg, I; Kutyifa, V

Published Date

  • November 1, 2022

Published In

Volume / Issue

  • 182 /

Start / End Page

  • 32 - 39

PubMed ID

  • 36075757

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2022.07.018


  • eng

Conference Location

  • United States