Efficacy of Long Detection Interval ICD Settings in Secondary Prevention Population: Data from the Advance III Trial

Background —Three trials recently demonstrated that a long detection window reduce ICD therapy in primary prevention (PP) patients. Advance III was the only trial enrolling both PP and secondary prevention (SP) patients. Methods and Results —Out of 1902 patients enrolled in the ADVANCEIII trial, 477 received a defibrillator for SP : 248 pts were randomly assigned to a long detection setting (30/40 intervals) and 229 pts to the nominal setting (18/24 intervals) for ventricular arrhythmias (VA) with cycle length ≤320 ms. Patients were 85% men with mean age of 65±12, previous history of ventricular fibrillation in 37% of the cases and mean ejection fraction of 38%±13%. ICD device mix was 37% single, 47% dual and 16% triple chamber. Over a median period of 12 months, the long detection was associated with a 25% reduction in the number of overall therapies (115.6 rate per 100/pts years vs 86.8; IRR: 0.75 95%CI:0.61-0.93, p=0.008) and 34% reduction in the number of shocks (51.2 rate per 100 pts years vs 38.1; IRR: 0.66; 95%CI:0.48-0.89, p=0.007). Appropriate therapies (89.7 vs 67.7; IRR: 0.77 95%CI:0.60-0.97, p=0.029) and appropriate shocks (37.1 vs 28.1; IRR:0.64 95%CI:0.45-0.93, p=0.018) were also reduced. Conclusions —Advance III is the first randomized trial that assessed an ICD long detection window setting in both PP and SP populations and demonstrates a reduction of overall therapies and shocks in the subgroup of SP patients. These data suggest that even SP population may benefit from a programming that combines a long detection with ATP during charging. Clinical Trial Registration Information —clinicaltrials.gov. Identifier: [NCT00617175][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00617175&atom=%2Fcirculationaha%2Fearly%2F2014%2F05%2F16%2FCIRCULATIONAHA.114.009468.atom