Trends in implantable cardioverter-defibrillator programming practices and its impact on therapies: Insights from a North American Remote Monitoring Registry 2007-2018.

Abstract Background Recent evidence has revealed the utility of prolonged arrhythmia detection duration and increased rate cutoff to reduce implantable cardioverter-defibrillator (ICD) therapies. Data on real-world trends in ICD programming and its impact on outcomes are limited. Objective Evaluate trends in ICD programming and its impact on ICD therapy using a large remote monitoring database. Methods A retrospective analysis of ICD patients implanted from 2007-2018 was conducted using the de-identified Medtronic CareLink Database. Data on ICD programming (number of intervals to detection (NID) and therapy rate cutoff) and delivered ICD therapies were collected. Results Among 210,810 patients, the proportion programmed to a rate cutoff ≥ 188 bpm increased from 41% to 49% and an NID of ≥ 30/40 increased from 17% to 67% from before May 2013 versus after February 2016. Programming to a rate cutoff ≥ 188 bpm, ventricular fibrillation (VF) NID ≥ 30/40 or combined rate cutoff ≥ 188 bpm and VF NID ≥30/40 were associated with reductions in ICD therapy. The largest reductions in ICD therapy occurred when the combination of rate cutoff ≥ 188 bpm and VF NID ≥ 30/40 was programmed (anti-tachycardia pacing (ATP): hazard ratio (HR): 0.35, confidence interval (CI): 0.34-0.36, p Conclusions Despite evidence supporting the use of prolonged detection duration and high rate cutoff, implementation of shock reduction programming strategies in real-world clinical practice has been modest. The use of evidence-based ICD programming is associated with reduced ICD shocks over long-term follow-up.