nach oben

06.12.2018 | Ausgabe 3/2019

Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices

Zeitschrift:: Journal of Interventional Cardiac Electrophysiology > Ausgabe 3/2019

Autoren:: Sem Briongos-Figuero, Ana Sánchez, M. Luisa Pérez, José B. Martínez-Ferrer, Enrique García, Xavier Viñolas, Ángel Arenal, Javier Alzueta, Nuria Basterra, Aníbal Rodríguez, Ignacio Lozano, Roberto Muñoz-Aguilera

Abstract

Purpose

Comparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators.

Methods

All heart failure (HF) patients without an indication for pacing and implanted with a prophylactic ICD were recruited from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.

Results

Among 782 patients, single-chamber ICDs were implanted in 537 (68.7%) and dual-chamber devices in 245 (31.3%). During a mean follow-up of 52.2 ± 24.5 months, 109 inappropriate shocks were delivered in 49 patients (6.2%). In the propensity-score-matched analysis, dual-chamber ICDs were related to lower rates of inappropriate shocks as compared to single-chamber devices (0.9% vs. 11.8%, p = < 0.001, log-rank test). In multivariable Cox proportional analysis, independent predictors of inappropriate shock were history of atrial fibrillation (hazard ratio (HR) = 2.78, CI 1.37–5.64, p = 0.004), chronic kidney disease (HR = 6.15, CI 2.82–13.53, p < 0.001), and non-ischemic cardiomyopathy (HR = 2.84, CI 1.54–5.23, p = 0.001). Among ICD settings, PR logic was the only discriminator independently related to a reduced risk of inappropriate shocks (HR = 0.18, CI 0.06–0.48, p = 0.001), along with an SVT limit enabled over 200 bpm (HR = 0.24, CI 0.11–0.51, p < 0.001).

Conclusions

In this nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were related to lower risk of inappropriate shocks compared to single-chamber ICDs. Besides, PR logic and SVT limit > 200 bpm emerged as protective factors.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Jetzt einloggen Kostenlos registrieren

★ PREMIUM-INHALT

e.Med Interdisziplinär

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag als Mediziner

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

Jetzt gratis testen * Jetzt kaufen

Sie können e.Med Interdisziplinär 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

e.Med Innere Medizin

Kombi-Abonnement

Mit e.Med Innere Medizin erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Innere Medizin, den Premium-Inhalten der internistischen Fachzeitschriften, inklusive einer gedruckten internistischen Zeitschrift Ihrer Wahl.

Jetzt testen ¹

Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the Europe. Eur Heart J. 2015;36(41):2793–867. https://doi.org/10.1093/eurheartj/ehv316. CrossRefPubMed

Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359(10):1009–17. https://doi.org/10.1056/NEJMoa071098. CrossRefPubMedPubMedCentral

Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm. 2010;7(3):353–60. https://doi.org/10.1016/j.hrthm.2009.11.027. CrossRefPubMed

Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation. 2002;105(5):589–94. CrossRefPubMed

Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367(24):2275–83. https://doi.org/10.1056/NEJMoa1211107. CrossRefPubMed

Fischer A, Ousdigian KT, Johnson JW, Gillberg JM, Wilkoff BL. The impact of atrial fibrillation with rapid ventricular rates and device programming on shocks in 106,513 ICD and CRT-D patients. Heart Rhythm. 2012;9(1):24–31. https://doi.org/10.1016/j.hrthm.2011.08.005. CrossRefPubMed

Theuns DAMJ, Klootwijk APJ, Goedhart DM, Jordaens LJLM. Prevention of inappropriate therapy in implantable cardioverter-defibrillators: results of a prospective, randomized study of tachyarrhythmia detection algorithms. J Am Coll Cardiol. 2004;44(12):2362–7. https://doi.org/10.1016/j.jacc.2004.09.039. CrossRefPubMed

Friedman PA, McClelland RL, Bamlet WR, Acosta H, Kessler D, Munger TM, et al. Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: the detect supraventricular tachycardia study. Circulation. 2006;113(25):2871–9. https://doi.org/10.1161/CIRCULATIONAHA.105.594531. CrossRefPubMed

Gold MR, Ahmad S, Browne K, Berg KC, Thackeray L, Berger RD. Prospective comparison of discrimination algorithms to prevent inappropriate ICD therapy: primary results of the Rhythm ID Going Head to Head Trial. Heart Rhythm. 2012;9(3):370–7. https://doi.org/10.1016/j.hrthm.2011.10.004. CrossRefPubMed

10.

Olshansky B, Day JD, Moore S, Gering L, Rosenbaum M, McGuire M, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AVSH in ICDs) study. Circulation. 2007;115(1):9–16. https://doi.org/10.1161/CIRCULATIONAHA.106.629428. CrossRefPubMed

11.

Almendral J, Arribas F, Wolpert C, Ricci R, Adragao P, Cobo E, et al. Dual-chamber defibrillators reduce clinically significant adverse events compared with single-chamber devices: results from the DATAS (Dual chamber and Atrial Tachyarrhythmias Adverse events Study) trial. Europace. 2008;10(5):528–35. https://doi.org/10.1093/europace/eun072. CrossRefPubMed

12.

Friedman PA, Bradley D, Koestler C, Slusser J, Hodge D, Bailey K, et al. A prospective randomized trial of single- or dual-chamber implantable cardioverter-defibrillators to minimize inappropriate shock risk in primary sudden cardiac death prevention. Europace. 2014;16(10):1460–8. https://doi.org/10.1093/europace/euu022. CrossRefPubMed

13.

Kolb C, Sturmer M, Sick P, Reif S, Davy JM, Molon G, et al. Reduced risk for inappropriate implantable cardioverter-defibrillator shocks with dual-chamber therapy compared with single-chamber therapy: results of the randomized OPTION study. JACC Heart Fail. 2014;2(6):611–9. https://doi.org/10.1016/j.jchf.2014.05.015. CrossRefPubMed

14.

van Rees JB, Borleffs CJW, de Bie MK, Stijnen T, van Erven L, Bax JJ, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57(5):556–62. https://doi.org/10.1016/j.jacc.2010.06.059. CrossRefPubMed

15.

Peterson PN, Greenlee RT, Go AS, Magid DJ, Cassidy-Bushrow A, Garcia-Montilla R, Masoudi FA. Comparison of inappropriate shocks and other health outcomes between single- and dual-chamber implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: results from the cardiovascular research network longitudinal study of I. J Am Heart Assoc 2017;6(11). doi: https://doi.org/10.1161/JAHA.117.006937.

16.

Konstantino Y, Haim M, Boxer J, Goldenberg I, Feldman A, Michowitz Y, et al. Clinical outcomes of single- versus dual-chamber implantable cardioverter defibrillators: lessons from the Israeli ICD Registry. J Cardiovasc Electrophysiol. 2016;27(6):718–23. https://doi.org/10.1111/jce.12953. CrossRefPubMed

17.

Ruwald A-CH, Sood N, Ruwald MH, Jons C, Clyne CA, McNitt S, et al. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT. J Cardiovasc Electrophysiol. 2013;24(6):672–9. https://doi.org/10.1111/jce.12099. CrossRefPubMed

18.

Weeke P, Johansen JB, Jorgensen OD, Nielsen JC, Moller M, Videbaek R, et al. Mortality and appropriate and inappropriate therapy in patients with ischaemic heart disease and implanted cardioverter-defibrillators for primary prevention: data from the Danish ICD Register. Europace. 2013;15(8):1150–7. https://doi.org/10.1093/europace/eut017. CrossRefPubMed

19.

Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm. 2016;13(2):e50–86. https://doi.org/10.1016/j.hrthm.2015.11.018. CrossRefPubMed

20.

Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288(24):3115–23. CrossRefPubMed

21.

Kuhlkamp V, Dornberger V, Mewis C, Suchalla R, Bosch RF, Seipel L. Clinical experience with the new detection algorithms for atrial fibrillation of a defibrillator with dual chamber sensing and pacing. J Cardiovasc Electrophysiol. 1999;10(7):905–15. CrossRefPubMed

22.

Deisenhofer I, Kolb C, Ndrepepa G, Schreieck J, Karch M, Schmieder S, et al. Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defibrillators in reducing inappropriate therapies? A randomized, prospective study. J Cardiovasc Electrophysiol. 2001;12(2):134–42. CrossRefPubMed

23.

Gasparini M, Proclemer A, Klersy C, Kloppe A, Lunati M, Ferrer JBM, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA. 2013;309(18):1903–11. https://doi.org/10.1001/jama.2013.4598. CrossRefPubMed

24.

Wilkoff BL, Kuhlkamp V, Volosin K, Ellenbogen K, Waldecker B, Kacet S, et al. Critical analysis of dual-chamber implantable cardioverter-defibrillator arrhythmia detection: results and technical considerations. Circulation. 2001;103(3):381–6. CrossRefPubMed

25.

Kuhlkamp V, Wilkoff BL, Brown AB, Volosin KJ, Hugl BJ, Stafford W, et al. Experience with a dual chamber implantable defibrillator. Pacing Clin Electrophysiol. 2002;25(7):1041–8. CrossRefPubMed

26.

Dijkman B, Wellens HJ. Dual chamber arrhythmia detection in the implantable cardioverter defibrillator. J Cardiovasc Electrophysiol. 2000;11(10):1105–15. CrossRefPubMed

27.

Auricchio A, Schloss EJ, Kurita T, Meijer A, Gerritse B, Zweibel S, et al. Low inappropriate shock rates in patients with single- and dual/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results. Heart Rhythm. 2015;12(5):926–36. https://doi.org/10.1016/j.hrthm.2015.01.017. CrossRefPubMed

Titel: Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices
Autoren:: Sem Briongos-Figuero
Ana Sánchez
M. Luisa Pérez
José B. Martínez-Ferrer
Enrique García
Xavier Viñolas
Ángel Arenal
Javier Alzueta
Nuria Basterra
Aníbal Rodríguez
Ignacio Lozano
Roberto Muñoz-Aguilera
Publikationsdatum: 06.12.2018
DOI: https://doi.org/10.1007/s10840-018-0494-0
Verlag: Springer US
Zeitschrift: Journal of Interventional Cardiac Electrophysiology An International Journal of Cardiac Arrhythmias and Rhythm Management
Ausgabe 3/2019
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595

Sie können e.Med Innere Medizin 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

Neu im Fachgebiet Kardiologie

Kann „Dr. KI“ die künftige Entwicklung von Vorhofflimmern vorhersagen?

In Kooperation mit:: Kardiologie.org

03.03.2021 | Borderline Typus | Nachrichten

„The fast and the furious“ – eine Erklärung für Borderline?

Echte Statin-Nebenwirkung oder Nocebo? So lässt sich das herausfinden

In Kooperation mit:: Kardiologie.org

Reicht ein Troponin-Test aus, um Patienten zu entlassen?

In Kooperation mit:: Kardiologie.org

weitere anzeigen

Bestellen Sie unseren kostenlosen Newsletter Update Kardiologie und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Bildnachweise

Mail Icon II

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

e.Med Innere Medizin

Weitere Artikel der Ausgabe 3/2019

Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation

Clinical evidence of autonomic dysfunction due to atrial fibrillation: implications for rhythm control strategy

Unipolar electrogram-guided radiofrequency catheter ablation in paroxysmal atrial fibrillation: electrogram patterns and outcomes

The low specificity of low voltage bridges associating atrioventricular nodal reentry in pediatric patients

Long-term outcome of catheter ablation for atrial tachyarrhythmias in patients with atrial septal defect

Improvement in ejection fraction after cryoballoon pulmonary vein isolation for atrial fibrillation in individuals with systolic dysfunction

Neu im Fachgebiet Kardiologie

Kann „Dr. KI“ die künftige Entwicklung von Vorhofflimmern vorhersagen?

„The fast and the furious“ – eine Erklärung für Borderline?

Echte Statin-Nebenwirkung oder Nocebo? So lässt sich das herausfinden

Reicht ein Troponin-Test aus, um Patienten zu entlassen?

Newsletter