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Updated meta-analysis on implantable cardioverter defibrillator detection programming to reduce mortality

Carlo Bonanno MD*, Mariemma Paccanaro, MD; Leonardo Varotto, MD

Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times or high arrhythmia detection rates on ICD shock therapy and other adverse outcomes.

Background: Programming long arrhythmia detection time or high arrhythmia detection rate reduce the incidence of implantable cardioverter defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope.

Methods: PUBMED database was systematically searched. We included only randomized, prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times or higher vs lower ICD arrhythmia detection rates on clinical outcomes. Summary estimates of the relative risk (RR) of death, syncope, and total, appropriate and inappropriate shocks were calculated using random effects model.

Results: Six studies enrolling 6,543 patients were identified. During a mean/median follow-up of 1 to 1.5 years, there were 405 deaths, 156 patients experienced syncope, 367 received an appropriate shock, and 291 an inappropriate shock. In the experimental group there were significant reductions in mortality (RR=0.73, 95% confidence interval [CI] 0.60-0.88), and inappropriate shocks (RR=0.50 0, 95% CI 0.39-0.63), without affecting syncope (RR=1.31, 95% CI 0.95-1.80). Conclusion: ICD reduction programming therapy is an important strategy, decreasing the burden of inappropriate shocks and all-cause mortality in ICD recipients, without significant increase in syncope.