Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac resynchronization therapy patients

Journal of Cardiovascular Electrophysiology
B L WilkoffWilliam T Abraham

Abstract

Although numerous trials have shown benefit of implantable cardioverter defibrillators (ICDs) for either primary or secondary prevention, no trial has prospectively enrolled patients from both indications and analyzed ICD utilization between groups. We performed a retrospective review of MIRACLE ICD, a randomized, prospective double-blind trial of cardiac resynchronization therapy (CRT) in the ICD population. Both secondary prevention (N = 563) and primary prevention patients (N = 415) were enrolled. Subgroup analysis for frequency of ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes and detection accuracy revealed that primary prevention patients had a significantly lower frequency of appropriate episodes (0.09 vs 0.43 episodes/month) at significantly faster cycle lengths (303 +/- 54 ms vs 366 +/- 71 ms, P < 0.0001). These episodes were more likely to be classified as VF by the device and thus receive shock therapy (42% by device classification vs 19% in secondary prevention, P < 0.0001). The absolute rate of inappropriate detections in the primary prevention group per month of follow-up was lower but constituted a much higher proportion of all episodes (30% vs 14%, P < 0.0001). Most inappropriate detecti...Continue Reading

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