ReviewFrequency and Causes of Implantable Cardioverter-Defibrillator Therapies: Is Device Therapy Proarrhythmic?
Section snippets
Methods
We performed a Medline search for all English-language reports cross referencing the following keywords: implantable cardioverter-defibrillator, cardiac resynchronization therapy, and cardiac resynchronization therapy–defibrillator with appropriate therapy, inappropriate therapy, shocks, mortality, sudden death, and cardiac arrest. We initially reviewed major randomized controlled clinical trials published after 1995. Studies involving ICDs without sufficient data retrieval capabilities to
Results
Key aspects of the 7 major ICD trials reviewed are listed in Table 1.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 Available mortality and ICD therapy rates from the ICD trials appear in Figure 1. A number of important ICD trials (e.g., the Coronary Artery Bypass Graft Patch Trial, the Multicenter Automatic Defibrillator Implantation Trial) were not included in our analysis for the reasons stated in the Methods section.
Inappropriate ICD therapies were common in the trials for which they were
Discussion
Recent ICD trials have demonstrated relatively high rates of inappropriate and appropriate therapies. This discussion focuses on the causes of inappropriate and appropriate ICD shocks, as well as methods to decrease their incidence. The adverse effects of potentially avoidable therapies and their clinical implications are addressed.
In contemporary trials, 25% to 35% of all ICD therapies have been classified as inappropriate.15, 24, 26 Supraventricular tachyarrhythmias (including sinus
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Cited by (0)
Dr. Essebag is the recipient of a Clinician Scientist Award from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
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Dr. Josephson is a consultant for the Medtronic Foundation, Inc., Minneapolis, Minnesota