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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses findings from the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy [MADIT-RIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00947310\u0026amp;atom=%2Fspmdc%2F12%2F18%2F21.atom\u0022\u003ENCT00947310\u003C\/a\u003E] that were simultaneously published in the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E [Moss AJ et al. 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EArthur J. Moss, MD, University of Rochester Medical Center, Rochester, New York, USA, presented findings from the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy [MADIT-RIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00947310\u0026amp;atom=%2Fspmdc%2F12%2F18%2F21.atom\u0022\u003ENCT00947310\u003C\/a\u003E] that were simultaneously published in the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E [Moss AJ et al. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EInappropriate therapy delivered by implantable cardioverter-defibrillators (ICDs) is defined as ICD therapies that are triggered by nonventricular tachyarrhythmias. These errors occur frequently despite sophisticated device-related detection algorithms designed to differentiate supraventricular from ventricular tachyarrhythmias [Moss AJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012]. Activations that fail to make this distinction can have potentially life-threatening consequences [Daubert JP et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EMADIT-RIT was a global, prospective, randomized, nonblinded, 3-arm, multicenter clinical investigation performed at 98 hospital centers in the United States, Europe, Canada, Israel, and Japan from September 15, 2009, through trial termination on July 10, 2012. The study assessed specific programming features for reducing inappropriate therapy in patients with ICDs.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary objective was to determine whether programmed high-rate therapy (with a 2.5-second delay before the initiation of therapy at a heart rate of \u2265200 beats per minute [bpm]) or delayed therapy (with a 60-second delay at 170 to 199 bpm, a 12-second delay at 200 to 249 bpm, and a 2.5-second delay at \u2265250 bpm) was associated with a decrease in the number of patients with a first occurrence of inappropriate antitachycardia pacing or shocks compared with conventional programming (with a 2.5-second delay at 170 to 199 bpm and a 1.0-second delay at \u2265200 bpm). The secondary endpoints were death from any cause and the first episode of syncope.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA total of 1500 patients were randomized to high-rate therapy (n=500), delayed therapy (n=486), or conventional therapy (n=514). Baseline characteristics were similar. During a mean follow-up of 1.4 years, high-rate therapy and delayed ICD therapy significantly reduced inappropriate therapy compared with conventional therapy\u2014high-rate therapy vs conventional therapy (HR, 0.21; 95% CI, 0.13 to 0.34; p\u0026lt;0.001), delayed therapy vs conventional therapy (HR, 0.24; 95% CI, 0.15 to 0.40; p\u0026lt;0.001)\u2014and reduced all-cause mortality (HR, 0.45; 95% CI, 0.24 to 0.85; p=0.01; HR, 0.56; 95% CI, 0.30 to 1.02; p=0.06; respectively for the same comparisons). The frequency of a first episode of syncope was similar in the 3 treatment groups: high-rate therapy (22), delayed therapy (23), and conventional therapy (23).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ECompared with conventional programming, ICD therapies for tachyarrhythmias of 200 bpm or higher, or with a prolonged delay in therapy at 170 bpm or higher are associated with reductions in inappropriate therapy and all-cause mortality during long-term follow-up. Wilkoff [\u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] noted in a related editorial that the value of ICD therapy is greatly influenced and in many ways determined by the programming choices made by the physician. The results of MADIT-RIT call for careful reconsideration of the previously measured effects of ICD therapy on morbidity and mortality. A patient\u0027s unnecessary exposure to painful shocks and his or her survival may depend on programming choices.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/18\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn6ep\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}