METHODS AND RESULTS:
Prospective cohort with historical controls. HF patients with a
primary-prevention indication for a defibrillator were randomized to
receive one of two new programming configurations (high-rate or delayed
therapies). A historical cohort of patients with conventional
programming was analyzed for comparison. The primary endpoint was any
therapy [shock or anti-tachycardia pacing (ATP)] delivered.
Secondary endpoints were appropriate shocks, appropriate ATP,
appropriate therapies, inappropriate shocks, syncope and death. 89
patients were assigned for new programming group [high rate (n=47) or
delayed therapy (n=42)]. They were compared with 94 historical
patients with conventional programming. During a mean follow-up of 20±7
months, the new programming was
associated with a reduction of any therapy (HR = 0.265, 95% CI
0.121-0.577, p=0.001), even after adjustment. Aproppriate ATP and any
shock were also reduced. Syncope did not occur. Sudden, cardiovascular
and all-cause deaths were not different between the groups. In the new
programming group, neither high-rate nor delayed programming were better
than the other.
CONCLUSIONS: In our study, programming tachycardia zones
homogeneously across all manufacturers was possible and resulted in a
lower rate of therapies, shocks and appropriate ATP.
Keywords: defibrillator; primary prevention; programming;
shocks; anti-tachycardia pacing; avoidable shocks.