TY - JOUR
T1 - Relationship between age and inappropriate implantable cardioverter-defibrillator therapy in MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy)
AU - Biton, Yitschak
AU - Huang, David T.
AU - Goldenberg, Ilan
AU - Rosero, Spencer
AU - Moss, Arthur J.
AU - Kutyifa, Valentina
AU - McNitt, Scott
AU - Strasberg, Boris
AU - Zareba, Wojciech
AU - Barsheshet, Alon
N1 - Publisher Copyright:
© 2016 Heart Rhythm Society.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background There is limited data regarding the relationship between age and inappropriate therapy among patients with an implantable cardioverter-defibrillator (ICD) and resynchronization therapy. Objectives We aimed to investigate this relationship and the effect of ICD programming on inappropriate therapy by age. Methods In the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) 1500 patients were randomized to 3 ICD programming arms: (A) conventional with ventricular tachycardia (VT) therapy ≥170; (B) high-rate cutoff with VT therapy ≥200, and (C) prolonged 60-second delay for VT therapy ≥170. We investigated the relationship between age, the risk of inappropriate ICD therapy (including antitachycardia pacing [ATP] or shock), and ICD programming. Results Cumulative incidence function Kaplan-Meier graphs showed an inverse relationship between increasing quartiles of age (Q1: ≤55, Q2: 56-64, Q3: 65-71, and Q4: ≥72 years) and the risk for inappropriate therapy. Multivariate analyses showed that each increasing decade of life was associated with 34% (P <.001), 27% (P <.001), and 26% (P <.001) reduction in the risk of inappropriate shock, inappropriate ATP, and any inappropriate therapy, respectively. Treatment arms B and C as compared with arm A were associated with a significant reduction in the risk of inappropriate therapies across all age quartiles (P <.001 for all). Conclusions Among patients with a primary prevention indication for an ICD, there is an inverse relationship between age and inappropriate ICD therapy. Innovative ICD programming of high-rate cutoff or prolonged delay for VT therapy is associated with significant reductions in inappropriate therapy among all age groups.
AB - Background There is limited data regarding the relationship between age and inappropriate therapy among patients with an implantable cardioverter-defibrillator (ICD) and resynchronization therapy. Objectives We aimed to investigate this relationship and the effect of ICD programming on inappropriate therapy by age. Methods In the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) 1500 patients were randomized to 3 ICD programming arms: (A) conventional with ventricular tachycardia (VT) therapy ≥170; (B) high-rate cutoff with VT therapy ≥200, and (C) prolonged 60-second delay for VT therapy ≥170. We investigated the relationship between age, the risk of inappropriate ICD therapy (including antitachycardia pacing [ATP] or shock), and ICD programming. Results Cumulative incidence function Kaplan-Meier graphs showed an inverse relationship between increasing quartiles of age (Q1: ≤55, Q2: 56-64, Q3: 65-71, and Q4: ≥72 years) and the risk for inappropriate therapy. Multivariate analyses showed that each increasing decade of life was associated with 34% (P <.001), 27% (P <.001), and 26% (P <.001) reduction in the risk of inappropriate shock, inappropriate ATP, and any inappropriate therapy, respectively. Treatment arms B and C as compared with arm A were associated with a significant reduction in the risk of inappropriate therapies across all age quartiles (P <.001 for all). Conclusions Among patients with a primary prevention indication for an ICD, there is an inverse relationship between age and inappropriate ICD therapy. Innovative ICD programming of high-rate cutoff or prolonged delay for VT therapy is associated with significant reductions in inappropriate therapy among all age groups.
KW - Age
KW - Cardiac resynchronization therapy with defibrillator
KW - Implantable cardioverter-defibrillator
KW - Inappropriate ICD therapy
KW - Supra ventricular arrhythmia
UR - http://www.scopus.com/inward/record.url?scp=84964653579&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2015.12.032
DO - 10.1016/j.hrthm.2015.12.032
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AN - SCOPUS:84964653579
SN - 1547-5271
VL - 13
SP - 888
EP - 893
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -