Author + information
- Received February 21, 2007
- Revision received September 19, 2007
- Accepted September 23, 2007
- Published online April 8, 2008.
- James P. Daubert, MD⁎,⁎ (, )
- Wojciech Zareba, MD, PhD⁎,
- David S. Cannom, MD†,
- Scott McNitt, MS⁎,
- Spencer Z. Rosero, MD⁎,
- Paul Wang, MD‡,
- Claudio Schuger, MD§,
- Jonathan S. Steinberg, MD∥,
- Steven L. Higgins, MD¶,
- David J. Wilber, MD#,
- Helmut Klein, MD⁎⁎,
- Mark L. Andrews, BBA⁎,
- W. Jackson Hall, PhD††,
- Arthur J. Moss, MD⁎,
- MADIT II Investigators
- ↵⁎Reprint requests and correspondence:
Dr. James P. Daubert, Box 679-URMC, Rochester, New York 14642.
Objectives This study sought to identify the incidence and outcome related to inappropriate implantable cardioverter-defibrillator (ICD) shocks, that is, those for nonventricular arrhythmias.
Background The MADIT (Multicenter Automatic Defibrillator Implantation Trial) II showed that prophylactic ICD implantation improves survival in post-myocardial infarction patients with reduced ejection fraction. Inappropriate ICD shocks are common adverse consequences that may impair quality of life.
Methods Stored ICD electrograms from all shock episodes were adjudicated centrally. An inappropriate shock episode was defined as an episode during which 1 or more inappropriate shocks occurred; another inappropriate ICD episode occurring within 5 min was not counted. Programmed parameters for patients with and without inappropriate shocks were compared.
Results One or more inappropriate shocks occurred in 83 (11.5%) of the 719 MADIT II ICD patients. Inappropriate shock episodes constituted 184 of the 590 total shock episodes (31.2%). Smoking, prior atrial fibrillation, diastolic hypertension, and antecedent appropriate shock predicted inappropriate shock occurrence. Atrial fibrillation was the most common trigger for inappropriate shock (44%), followed by supraventricular tachycardia (36%), and then abnormal sensing (20%). The stability detection algorithm was programmed less frequently in patients receiving inappropriate shocks (17% vs. 36%, p = 0.030), whereas other programming parameters did not differ significantly from those without inappropriate shocks. Importantly, patients with inappropriate shocks had a greater likelihood of all-cause mortality in follow-up (hazard ratio 2.29, p = 0.025).
Conclusions Inappropriate ICD shocks occurred commonly in the MADIT II study, and were associated with increased risk of all-cause mortality.
Supported by a research grant from Guidant Corporation, St. Paul, Minnesota, to The University of Rochester Medical Center.
- Received February 21, 2007.
- Revision received September 19, 2007.
- Accepted September 23, 2007.
- American College of Cardiology Foundation