Inappropriate shock rates driven lower with "smart" programming: Very good news in ICD therapy

From: The

"It's time to revisit the therapy of sudden cardiac death"

Dr John Camm, EUROPACE 2013

Implantable cardioverter-defibrillator (ICD) therapy for the treatment of sudden cardiac death has undergone major improvements in the past year. This is welcome news for both patients and caregivers. I am happy to report a late-breaking clinical trial from EUROPACE 2013 that delivers really good news about ICD therapy.

First the background:

Despite major advances in cardiology in the past decade, sudden cardiac death remains the number-one cause of death. Estimates vary, but it's likely that more than 200 000 humans die suddenly each year from ventricular tachyarrhythmia.

The ICD remains the only reliable way to treat this disease. Once ventricular fibrillation occurs, the likelihood of meaningful survival without an ICD remains very low.

The problem with ICD therapy has always been the benefit-to-burden ratio. In another era of medicine (a decade ago), clinical trials showed that selected patients at high risk for sudden death gained small but statistically significant mortality advantages with an ICD. For every 100 patients implanted with an ICD, only five to seven patients experience a life-saving shock. The rest are exposed to the risks but get no benefit.

Such small gains would not be an issue if the burdens weren't so great. One of the most devastating burdens of an ICD is inappropriate shocks. High-voltage internal shocks delivered in a fully awake patient are a huge problem. You just can't shock a person and expect no consequences. Shocks have been associated with anxiety, increased healthcare use, decreased quality of life, and even higher mortality. Until recently, the rate of inappropriate shocks has ranged between 5% and 15%. That's too high.

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