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Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis.

Publication ,  Journal Article
Kutyifa, V; Daubert, JP; Olshansky, B; Huang, DT; Zhang, C; Ruwald, A-CH; McNitt, S; Zareba, W; Moss, AJ; Schuger, C
Published in: Heart Rhythm
September 2015

BACKGROUND: Data on inappropriate implantable cardioverter-defibrillator (ICD) therapy and effects of programming by heart rate are lacking. OBJECTIVE: We aimed to characterize inappropriate ICD therapy and assess the effects of novel programming by heart rate. METHODS: Incidence and causes of inappropriate therapy by heart rate range (below or above 200 bpm) were assessed. Predictors of inappropriate therapy and effects of programming by heart rate were evaluated with multivariate Cox regression models. Crossovers were excluded. RESULTS: Inappropriate therapy occurred in 9.2% of the total patient population, with 19% of patients randomized to study arm A, 3.6% in arm B, and 4.7% in arm C. Inappropriate therapies <200 bpm were attributable to supraventricular tachycardia (SVT)/sinus tachycardia (78%) or atrial fibrillation/flutter (20%). Inappropriate therapy ≥200 bpm occurred because of SVT (47%), atrial fibrillation/flutter (41%), or electromagnetic interference (13%). Conventional ICD programming was associated with more inappropriate therapy <200 bpm than high-rate or delayed therapy, as were younger age, history of atrial arrhythmia, advanced New York Heart Association functional class, ICD versus cardiac resynchronization therapy with defibrillator, and absence of diabetes. High-rate and long-delay therapy significantly reduced the risk of inappropriate therapy in the <200 bpm range. Long delay was associated with further reduction of fast (≥200 bpm) inappropriate therapy (P = .032) and a reduction in subsequent inappropriate episodes (P = .006). CONCLUSION: In MADIT-RIT, inappropriate ICD therapy is most frequent at rates below 200 bpm and can be predicted, and effectively prevented, with high-rate cutoff programming. Long-delay therapy effectively reduces fast inappropriate therapy ≥200 bpm and subsequent events. [ CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov/ct2/show/NCT00947310].

Duke Scholars

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

September 2015

Volume

12

Issue

9

Start / End Page

2030 / 2037

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Tachycardia, Ventricular
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
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Kutyifa, V., Daubert, J. P., Olshansky, B., Huang, D. T., Zhang, C., Ruwald, A.-C., … Schuger, C. (2015). Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis. Heart Rhythm, 12(9), 2030–2037. https://doi.org/10.1016/j.hrthm.2015.05.021
Kutyifa, Valentina, James P. Daubert, Brian Olshansky, David T. Huang, Claire Zhang, Anne-Christine H. Ruwald, Scott McNitt, Wojciech Zareba, Arthur J. Moss, and Claudio Schuger. “Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis.Heart Rhythm 12, no. 9 (September 2015): 2030–37. https://doi.org/10.1016/j.hrthm.2015.05.021.
Kutyifa V, Daubert JP, Olshansky B, Huang DT, Zhang C, Ruwald A-CH, et al. Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis. Heart Rhythm. 2015 Sep;12(9):2030–7.
Kutyifa, Valentina, et al. “Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis.Heart Rhythm, vol. 12, no. 9, Sept. 2015, pp. 2030–37. Pubmed, doi:10.1016/j.hrthm.2015.05.021.
Kutyifa V, Daubert JP, Olshansky B, Huang DT, Zhang C, Ruwald A-CH, McNitt S, Zareba W, Moss AJ, Schuger C. Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis. Heart Rhythm. 2015 Sep;12(9):2030–2037.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

September 2015

Volume

12

Issue

9

Start / End Page

2030 / 2037

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Tachycardia, Ventricular
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Incidence