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Reduction of inappropriate anti-tachycardia pacing therapies and shocks by a novel suite of detection algorithms in heart failure patients with cardiac resynchronization therapy defibrillators: a historical comparison of a prospective database.
Lunati, Maurizio; Proclemer, Alessandro; Boriani, Giuseppe; Landolina, Maurizio; Locati, Emanuela; Rordorf, Roberto; Daleffe, Elisabetta; Ricci, Renato Pietro; Catanzariti, Domenico; Tomasi, Luca; Gulizia, Michele; Baccillieri, Maria Stella; Molon, Giulio; Gasparini, Maurizio.
Afiliação
  • Lunati M; 'A De Gasperis' Cardiac Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy maurizio.lunati@ospedaleniguarda.it.
  • Proclemer A; S. Maria della Misericordia Hospital, Udine, Italy.
  • Boriani G; University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
  • Landolina M; Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy Ospedale Maggiore, Crema (Cremona), Italy.
  • Locati E; 'A De Gasperis' Cardiac Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy.
  • Rordorf R; Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy.
  • Daleffe E; S. Maria della Misericordia Hospital, Udine, Italy.
  • Ricci RP; San Filippo Neri Hospital, Rome, Italy.
  • Catanzariti D; Santa Maria del Carmine Hospital, Rovereto, Italy.
  • Tomasi L; Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
  • Gulizia M; Ospedale Garibaldi Nesima, Catania, Italy.
  • Baccillieri MS; Ospedale P. Cosma, Camposampiero, Italy.
  • Molon G; Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
  • Gasparini M; IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
Europace ; 18(9): 1391-8, 2016 Sep.
Article em En | MEDLINE | ID: mdl-26826135
AIMS: Implantable cardioverter defibrillators improve survival of patients at risk for ventricular arrhythmias, but inappropriate shocks occur in up to 30% of patients and have been associated with worse quality of life and prognosis. In heart failure patients with cardiac resynchronization therapy defibrillators (CRT-Ds), we evaluated whether a new generation of detection and discrimination algorithms reduces inappropriate shocks. METHODS AND RESULTS: We analysed 1983 Medtronic CRT-D patients (80% male, 67 ± 10 years), 1368 with standard devices (Control CRT-D) and 615 with new generation devices (New CRT-D). Expert electrophysiologists reviewed and classified the electrograms of all device-detected ventricular tachycardia/fibrillation episodes. Total follow-up was 3751 patients-years. Incidence of inappropriate shocks at 1 year was 2.8% [95% confidence interval (CI) = 2.0-3.5] in Control CRT-D and 0.9% (CI = 0.4-2.2) in New CRT-D (hazard ratio = 0.37, CI = 0.21-0.66, P < 0.001). In New CRT-D, inappropriate shocks were reduced by 77% [incidence rate ratio (IRR) = 0.23, CI = 0.16-0.35, P < 0.001] and inappropriate anti-tachycardia pacing by 81% (IRR = 0.19, CI = 0.11-0.335, P < 0.001). Annual rate per 100 patient-years for appropriate VF detections was 3.0 (CI = 2.1-4.2) in New CRT-D and 3.2 (CI = 2.1-5.0) in Control CRT-D (P = 0.68), for syncope was 0.4 (CI = 0.2-0.9) in New CRT-D and 0.7 (CI = 0.5-1.0) in Control CRT-D (P = 0.266), and for death was 1.0 (CI = 0.6-1.6) in New CRT-D and 3.5 (CI = 3.0-4.1) in Control CRT-D (P < 0.001). CONCLUSION: Detection and discrimination algorithms used in new generation CRT-D significantly reduced inappropriate shocks when compared with standard CRT-D. This result, with no compromise on VF sensitivity or risk of syncope, has important implications for patients' quality of life and prognosis.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Ventricular / Algoritmos / Processamento de Sinais Assistido por Computador / Falha de Prótese / Cardioversão Elétrica / Taquicardia Ventricular / Desfibriladores Implantáveis / Técnicas Eletrofisiológicas Cardíacas / Terapia de Ressincronização Cardíaca / Dispositivos de Terapia de Ressincronização Cardíaca Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Ventricular / Algoritmos / Processamento de Sinais Assistido por Computador / Falha de Prótese / Cardioversão Elétrica / Taquicardia Ventricular / Desfibriladores Implantáveis / Técnicas Eletrofisiológicas Cardíacas / Terapia de Ressincronização Cardíaca / Dispositivos de Terapia de Ressincronização Cardíaca Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2016 Tipo de documento: Article