The impact of supraventricular arrhythmias on the outcomes of guideline‐compliant implantable cardioverter defibrillator programming

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 4; pp. 794 - 801
• Main Authors: Teerawongsakul, Padoemwut, Ananwattanasuk, Teetouch, Chokesuwattanaskul, Ronpichai, Shah, Muazzum, Lathkar‐Pradhan, Sangeeta, Barham, Waseem, Oral, Hakan, Thakur, Ranjan K., Jongnarangsin, Krit, Tanawuttiwat, Tanyanan
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2024
• Subjects: Arrhythmia; Arrhythmias, Cardiac; Cardiac arrhythmia; Death, Sudden, Cardiac - prevention & control; Defibrillators; Defibrillators, Implantable - adverse effects; Electric Countershock - adverse effects; Humans; ICD programming guideline; ICD shock; ICD therapy; implantable cardioverter defibrillator; Middle Aged; Mortality; primary prevention; supraventricular arrhythmia; primary prevention; ICD programming guideline; ICD therapy; supraventricular arrhythmia; implantable cardioverter defibrillator; ICD shock
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.16216

Introduction Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. Methods Consecutive patients who underwent ICD insertion for primary prevention were classified into four groups based on SVA status and ICD programming: (1) guideline‐concordant group (GC) with SVA, (2) GC without SVA, (3) nonguideline concordant group (NGC) with SVA, and (4) NGC without SVA. Cox proportional hazard models were analyzed for freedom from ICD therapies, shock, and mortality. Results Seven hundred and seventy‐two patients (median age, 64 years) were enrolled. ICD therapies were the most frequent in NGC with SVA (24.0%), followed by NGC without SVA (19.9%), GC without SVA (11.6%), and GC with SVA (8.1%). Guideline concordant programming was associated with 68% ICD therapy reduction (HR 0.32, p = .007) and 67% ICD shock reduction (HR 0.33, p = .030) in SVA patients and 44% ICD therapy reduction in those without SVA (HR 0.56, p = .030). Conclusion Programming ICDs in primary prevention patients based on current guidelines reduces therapy burden without increasing mortality in both SVA and non‐SVA patients. A greater magnitude of reduced ICD therapy was found in those with supraventricular arrhythmias. The impact of supraventricular arrhythmias on the outcomes of guideline‐compliance implantable cardioverter defibrillators programming.