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Circ Arrhythm Electrophysiol · Jan 2016
Randomized Controlled Trial Multicenter StudyNovel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients: A MADIT-RIT Sub-Study.
- Valentina Kutyifa, James P Daubert, Claudio Schuger, Ilan Goldenberg, Helmut Klein, Mehmet K Aktas, Scott McNitt, Martin Stockburger, Bela Merkely, Wojciech Zareba, and Arthur J Moss.
- From the University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY (V.K., I.G., H.K., M.K.A., S.M., W.Z., A.J.M.); Duke University Medical Center, Division of Cardiology, Durh... more
- Circ Arrhythm Electrophysiol. 2016 Jan 1; 9 (1): e001965.
BackgroundThe Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT.Methods And ResultsThe primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; P<0.001). High-rate cut-off or delayed ventricular tachycardia therapy programming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; P<0.001 for all). There was a significant reduction in inappropriate anti-tachycardia pacings in both group and a significant reduction in inappropriate ICD shock in CRT-D patients.ConclusionsPatients implanted with a CRT-D have lower risk of inappropriate ICD therapy than those with an ICD. Innovative ICD programming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients.Clinical Trial Registrationhttp://clinicaltrials.gov; Unique identifier: NCT00947310.© 2016 American Heart Association, Inc.
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