ICD programming

BACKGROUND

Appropriate ICD programming is the key to prevent inappropriate shock delivery, that is closely associated to a negative patients' outcome.

METHODS

Review of the literature on ICD therapy to generate ICD programmings that can be applied to the broad population of ICD and CRT-D carriers.

RESULTS

Arrhythmia detection should occur with a detection time ranging 9″-12″ in the VF zone, and 15″-60″ in the VT zone. Discriminator should be applied at least up to 200 bpm. ATP therapy is applied to all VTs up to 250 bpm, with a success rate of 70%. Inappropriate shocks should occur in <3.6% of patients.

CONCLUSION

Tailored ICD programming can be achieved following evidence from large ICD trials. Pre-defined settings that are saved on the programmer and that can be uploaded at device implantation help to ensure optimal programming and to avoid random errors.

Implantable cardioverter defibrillator and inappropriate therapy: "black box" examination yielded both human and technical causes

We report on a 70-year-old male patient who was recipient of GEM III DR 7275 Cardioverter Defibrillator, and who presented with inappropriate shocks. The patient had a documented slow ventricular tachycardia (VT), and the device was programmed to detect VT at rates >100 bpm, fast VT (FVT, via VT) at rates >150 bpm, and ventricular fibrillation (VF) at rates >188 bpm. After detection of FVT, efficient therapy was delivered; however, this was immediately followed by multiple inappropriate therapies. Inappropriate therapies were discussed, with a focus on programming features.