Prevention of inappropriate therapy in implantable defibrillators: A meta-analysis of clinical trials comparing single-chamber and dual-chamber arrhythmia discrimination algorithms
Introduction: A proposed benefit of dual-chamber arrhythmia discrimination is a reduction in inappropriate therapy in implantable cardioverter-defibrillators (ICDs). The aim of this meta-analysis was to establish whether dual-chamber arrhythmia discrimination algorithms reduce inappropriate device therapy. Methods and results: Public domain databases, MEDLINE, EMBASE, and Cochrane Register of Controlled Trials, were searched from 1996 to 2006. Two investigators abstracted data independently. Pooled estimates were calculated using both fixed-effects and random-effects models. We retrieved 5 prospective studies comparing dual-chamber with single-chamber arrhythmia discrimination, accumulating data on 748 patients. Pooled per-patient based analysis demonstrated that the number of patients receiving inappropriate ICD therapy was not different between single- and dual-chamber devices (odds ratio [OR] 1.23; 95% CI, 0.83 to 1.81; p = 0.31). Per-episode based analysis demonstrated a favoring benefit for dual-chamber arrhythmia discrimination (OR 0.64; 95% CI, 0.52 to 0.78; p < 0.001). A mean reduction of 1.1 inappropriately treated atrial episodes per patient was observed with dual-chamber arrhythmia discrimination (p < 0.001). Conclusions: Dual-chamber arrhythmia discrimination is associated with a reduction in the number of inappropriate treated episodes. The number of patients who experience inappropriate therapy is not reduced by dual-chamber discrimination.
|Keywords||Atrial arrhythmias, Implantable cardioverter-defibrillator, Inappropriate therapy, Meta-analysis, Ventricular arrhythmias|
|Persistent URL||dx.doi.org/10.1016/j.ijcard.2007.02.041, hdl.handle.net/1765/29432|
|Journal||International Journal of Cardiology|
Theuns, D.A.M.J, Rivero-Ayerza, M, Boersma, H, & Jordaens, L.J.L.M. (2008). Prevention of inappropriate therapy in implantable defibrillators: A meta-analysis of clinical trials comparing single-chamber and dual-chamber arrhythmia discrimination algorithms. International Journal of Cardiology, 125(3), 352–357. doi:10.1016/j.ijcard.2007.02.041