Advance III: Longer-interval ICDs offer some benefits

Programming implantable cardioverter-defibrillators (ICDs) with a longer detection time may be appropriate for many patients, based on results of the ADVANCE III trial. Researchers reported in the May 8 issue of the Journal of the American Medical Association that patients with longer-interval ICDs were less likely to experience antitachycardia pacing (ATP), shocks or be hospitalized compared with patients who received standard therapy.

In a late-breaking clinical trial at HRS.12, Maurizio Gasparini, MD, of the Humanitas Clinical and Research Center in Rome unveiled results for ADVANCE III (Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III) that showed longer-interval ICDs to be safe and effective. The multicenter, international study randomized 1,902 patients with newly implanted devices (including single chamber, dual chamber and cardiac resynchronization therapy-defibrillators) between 2008 and 2010 to therapies of either 30 of 40 intervals (long) or 18 of 24 intervals (standard). Median follow-up was 12 months.

In the JAMA article, Gasparini et al reported:

• A significantly lower combined incidence of ATP and shocks in the long-detection group compared with standard therapy;
• A significantly lower probability of receiving the first ATP or shock in the long-detection group;
• A lower all-cause hospitalization rate in the long-detection group;
• Similar increases in quality of life scores in both groups;
• Similar incidence of syncopal episodes; and
• Similar mortality rates.

“However, overall therapy-free survival as well as inappropriate shock-free survival estimate were improved in the long-detection group,” they wrote. “At present, the ‘out of the box’ settings used by some ICD manufacturers may be too conservative, with nominal treatment delays as short as one to three seconds. On the basis of the previous evidence and the current findings, it seems reasonable that a long-detection interval may be preferable in the majority of patients, especially when using an ICD with ATP-during-charge capability.”

Gasparini et al noted that devices in the trial were manufactured by only one company, and that some arrhythmia episodes may have been missed in the event of an electrical storm.

The study was funded by Medtronic.