Changes in implantable cardioverter defibrillator (ICD) programming may reduce the incidence of inappropriate shocks and are associated with reductions in all-cause mortality, according to results from the MADIT-RIT trial, presented as part of AHA 2012 on Nov. 6 and published simultaneously in The New England Journal of Medicine.

MADIT-RIT randomized 1,479 patients at 98 centers to conventional ICD and CRT-D device programming (activation at ≥170 beats per minute [bpm]), high-rate therapy (activation at ≥200 bpm), and duration-delay therapy (60 second monitoring before device firing at 170-199 bpm). Results showed that during an average follow-up of 1.4 years, high-rate therapy and delayed ICD therapy, as compared to conventional device programming, were associated with reductions in a first occurrence of inappropriate therapy (hazard ratio with high-rate therapy vs. conventional therapy, 0.21; 95 percent confidence interval [CI], 0.13 to 0.34; P<0.001; hazard ratio with delayed therapy vs. conventional therapy, 0.24; 95 percent CI, 0.15 to 0.40; P<0.001) and reductions in all-cause mortality (hazard ratio with high-rate therapy vs. conventional therapy 0.45; 95 percent CI, 0.24 to 0.85; P=0.01; hazard ratio with delayed therapy vs. conventional therapy 0.56; 95 percent CI, 0.30 to 1.02; P=0.06).