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Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device
BACKGROUND: Ventricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866326/ https://www.ncbi.nlm.nih.gov/pubmed/29475875 http://dx.doi.org/10.1161/JAHA.117.007748 |
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author | Richardson, Travis D. Hale, Leslie Arteaga, Christopher Xu, Meng Keebler, Mary Schlendorf, Kelly Danter, Matthew Shah, Ashish Lindenfeld, JoAnn Ellis, Christopher R. |
author_facet | Richardson, Travis D. Hale, Leslie Arteaga, Christopher Xu, Meng Keebler, Mary Schlendorf, Kelly Danter, Matthew Shah, Ashish Lindenfeld, JoAnn Ellis, Christopher R. |
author_sort | Richardson, Travis D. |
collection | PubMed |
description | BACKGROUND: Ventricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks. METHODS AND RESULTS: Adult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (P=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (P=0.08). CONCLUSIONS: An ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703. |
format | Online Article Text |
id | pubmed-5866326 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-58663262018-03-28 Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device Richardson, Travis D. Hale, Leslie Arteaga, Christopher Xu, Meng Keebler, Mary Schlendorf, Kelly Danter, Matthew Shah, Ashish Lindenfeld, JoAnn Ellis, Christopher R. J Am Heart Assoc Original Research BACKGROUND: Ventricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks. METHODS AND RESULTS: Adult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (P=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (P=0.08). CONCLUSIONS: An ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703. John Wiley and Sons Inc. 2018-02-23 /pmc/articles/PMC5866326/ /pubmed/29475875 http://dx.doi.org/10.1161/JAHA.117.007748 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Richardson, Travis D. Hale, Leslie Arteaga, Christopher Xu, Meng Keebler, Mary Schlendorf, Kelly Danter, Matthew Shah, Ashish Lindenfeld, JoAnn Ellis, Christopher R. Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title | Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title_full | Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title_fullStr | Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title_full_unstemmed | Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title_short | Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device |
title_sort | prospective randomized evaluation of implantable cardioverter‐defibrillator programming in patients with a left ventricular assist device |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866326/ https://www.ncbi.nlm.nih.gov/pubmed/29475875 http://dx.doi.org/10.1161/JAHA.117.007748 |
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