In patients implanted with a single chamber implantable cardioverter defibrillator (ICD), programming long detection may significantly reduce therapies, shocks and all-cause mortality, according to results from the ADVANCEIII Trial, presented May 11 as a Late-Breaking Clinical Trial during Heart Rhythm 2017 in Chicago, IL, and simultaneously published in JACC: Clinical Electrophysiology.

Maurizio Gasparini, MD, and colleagues examined 545 subjects receiving single chamber ICD who were randomized to long detection (30/40 intervals) or standard programming (18/24 intervals) based on device type, atrial fibrillation history and indication.

During a median follow-up of 12 months, 112 therapies were delivered in 34 of 267 patients in the long detection arm compared to 257 therapies in 60 of 278 patients in the control arm, translating to a 48 percent reduction with intervention. The number of shocks delivered was 40 percent less in the long detection group. Antitachycardia pacing delivery rates of 22 per 100 patient years in the long detection arm contrasted with 58 per 100 patient years in the control arm. There were 55 percent fewer appropriate therapies in the long detection arm compared to standard programming. Inappropriate therapies occurred infrequently in the study population, with a fewer inappropriate interventions reported in the long detection group. Syncope rates did not differ between groups but survival improved in the long detection arm.

“Our results have particular gravity since the ‘standard’ intervals applied in our control arm are longer than nominal ICD settings, indicating that even further prolongation of time to delivered therapy extends the advantages of this programming strategy further,” the authors write. 

Keywords: Atrial Fibrillation, Cardiovascular Diseases, Defibrillators, Implantable, Electrophysiology, Follow-Up Studies, Gravitation, Shock, Syncope

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