Long Term Course and Needs of ICD (Re-)Programming - Results of the German Medtronic Advanced Analytics Database

Introduction: ICD- and CRT-D systems offer a broad variety of ventricular arrhythmia (VA) therapeutic options. Actually, only little information is available about the course and programming characteristics in patients under remote monitoring. In this investigation, the course of parameters and re-programming after ICD intervention was analyzed. Methods: Follow-up data of Medtronic ICD and CRT-D have been studied by Medtronic AdvancedAnalytics (SQL database). Programmed parameters as well as EGMs, episode- and trend-data is stored and analyzed. Data after ICD intervention was investigated for changes in programming concerning detection settings, subdivided in detection zones, counters, discriminators, sensitivity, or polarity changes. Results: A total number of 19 472 follow-ups of 2 096 ICD and CRT-D devices between 2004 and 2016 were analyzed. The ICDs consisted of 496 (24%) single, 463 (22%) dual, and 1 137 (54%) triple-chamber devices. The data represent 3 089 device years. A total of 522 VF, FVT and VT treated eps were recorded and studied in 320 (15%) devices. Reprogrammed parameters consisted of: detection intervals in 64 (96%), detection counters in 43 (61%), discriminators in 33 (46%), and sensitivity in 1 patient (1 %). Discriminator changes consisted of: 10 SVT-Limit (14%), 7 Onset (10%), 15 PR-Logic (21%), 9 stability criteria (13%), and 3 Wavelet (4%). Time between ICD intervention and reprogramming was between 1 and 15 days. The Figure demonstrates the changes in detection setting during the course of the follow up. Conclusion: This analysis of ICD reprogramming after intervention shows that only in 13.7 % parameters were changed during the next session. These results of real world ICD programming in Germany merit further investigation to improve patient care by remote monitoring. Additionally, the results clearly show the penetration of recent studies in terms of changes in detection settings programmed.