This study was sponsored and funded by St. Jude Medical, Sylmar, CA.
Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock: Results from the PROVIDE Study
Article first published online: 24 SEP 2013
© 2014 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 25, Issue 1, pages 52–59, January 2014
How to Cite
SAEED, M., HANNA, I., ROBOTIS, D., STYPEREK, R., POLOSAJIAN, L., KHAN, A., ALONSO, J., NABUTOVSKY, Y. and NEASON, C. (2014), Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock: Results from the PROVIDE Study. Journal of Cardiovascular Electrophysiology, 25: 52–59. doi: 10.1111/jce.12273
Y. Nabutovsky and C. Neason are employees of St. Jude Medical and hold stock options in the company. R. Styperek owns some stock in St. Jude Medical. Other authors: No disclosures.
- Issue published online: 8 JAN 2014
- Article first published online: 24 SEP 2013
- Accepted manuscript online: 27 AUG 2013 10:36AM EST
- Manuscript Accepted: 19 AUG 2013
- Manuscript Revised: 14 AUG 2013
- Manuscript Received: 1 JUL 2013
- St. Jude Medical, Sylmar, CA
- implantable cardioverter defibrillator;
- antitachycardia pacing;
- ventricular tachycardia;
- ventricular fibrillation;
- sudden cardiac death;
- shock reduction;
- PROVIDE study
ICD Programming for Shock Reduction
Shock therapy delivery by implantable cardioverter-defibrillators (ICD) can be painful and may have adverse consequences. Reducing shock burden for patients with ICDs would be beneficial.
PROVIDE was a prospective, randomized study of primary prevention ICD patients. Patients in the experimental group received a combination of programmed parameters with higher detection rates, longer detection intervals, empiric antitachycardia pacing (ATP), and optimized supraventricular tachycardia (SVT) discriminators, while those in the control group were programmed with conventional parameters. Shock therapy and arrhythmic syncope were compared.
Of 1,670 patients enrolled (846 in the experimental group, 824 in the control group) and monitored over a follow-up of 530 ± 241 days, 202 patients received shock therapy for any cause (82 in the experimental group and 120 in the control group). The median time to first shock was significantly prolonged (13.1 vs 7.8 months, hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.47 to 0.82, P = 0.0005) and the 2-year shock rate significantly reduced (12.4% vs 19.4%, P < 0.001) in the experimental group compared to the control group. There was no increase in arrhythmic syncope (HR: 1.64, 95% CI: 0.69 to 3.90, P = 0.26), while the overall mortality was reduced (HR: 0.7, 95% CI: 0.50 to 0.98, P = 0.036) in the experimental group compared to the control group.
A combination of programmed parameters utilizing higher detection rate, longer detection intervals, empiric ATP, and optimized SVT discriminators reduced ICD therapies without increasing arrhythmic syncope and was associated with reduction in all-cause mortality among ICD patients.