**6. How to program implantable cardioverter defibrillator devices**

Current guidelines recommend conservative programming for ICD [34–37] based on good tolerance of VD and high rates of inappropriate shocks due to atrial tachycardia (AT), including atrial fibrillation (high rates in HF patients).

Richardson et al. [10] carry out an 83-patient randomized study (well-balanced between ischemic and non-ischemic cardiomyopathy) divided into a first standard programming arm according to the treating physician (**Table 2**) and a second ultraconservative ICD mode (**Table 3**).

As it is known, detection to rate and intervals to detection are important parameters to program an ICD to achieve the highest benefit and to avoid inappropriate shocks. The first one is related to the range of heart rate where ICD acts, and intervals are the numbers of cycles or time to detect before applying therapies. As **Table 1** shows, different therapy zones can be chosen, e.g., VT zone or VT1, VT2/VF zone, and VF zone based on these parameters to reach the optimal status for the patient. These zones must be correlated to patient profile, for instance, ischemic cardiomyopathy vs. myocardiopathy and primary vs. secondary prevention.

As indicated in **Table 3**, the ultra-conservative mode uses larger intervals of detection in the VF and VT zones and numerous anti-tachycardia pacing programming (ATP) therapies than the standard mode.

No difference related to time to the first ICD shock or the total number of shocks was found between the two groups. No statistical difference was observed in mortality terms, arrhythmic events, or heart failure hospitalization events. Inappropriate

*Implantable Cardioverter-Defibrillator Use in Patients with Left Ventricular Assist Devices DOI: http://dx.doi.org/10.5772/intechopen.109396*


#### **Table 2.**

*Adapted from Richardson et al. shows the programming values of ICD in the standard mode.*


#### **Table 3.**

*Adapted from Richardson et al. shows the programming values of the ICD in the ultraconservative mode.*

shocks resulted in 6% of the total population, although no significant differences between both groups were found [10].

However, the MADIT-RIT study showed fewer inappropriate shocks and lower allcause mortality in those patients scheduled for ICD therapies greater than 200 bpm [38]. This study compared conventional programming versus another more conservative population with prior AT and patients without prior AT and described a statistical reduction of inappropriate shocks with conservative programming able.

Moreover, a randomized ADVANCE III trial (1902 patients) also demonstrated that larger detection intervals (30 of 40 intervals) decreased therapies delivered and inappropriate shocks without difference in mortality or arrhythmic syncope events compared with standard detection (18 of 24 intervals) in not LVAD carriers [39].
