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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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 presents data from an international multicenter study, demonstrating that patients with dual-chamber (DC) implantable cardioverter defibrillators (ICDs) experienced a significantly lower incidence of inappropriate shocks compared with those with single-chamber devices, with no difference in all-cause mortality between the two groups. The Optimal Anti-tachycardia Therapy in ICD Patients Without Pacing Indications study [OPTION; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00729703\u0026amp;atom=%2Fspmdc%2F13%2F12%2F19.atom\u0022\u003ENCT00729703\u003C\/a\u003E] was designed to test the hypothesis that DC ICD therapy with specific device-based algorithms would reduce the rate of inappropriate shocks without affecting morbidity and mortality by ventricular pacing.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Cardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EChristof Kolb, MD, German Heart Centre\/Technische Universit\u00e4t M\u00fcnchen, Munich, Germany, presented data from an international multicenter study, demonstrating that patients with dual-chamber (DC) implantable cardioverter defibrillators (ICDs) experienced a significantly lower incidence of inappropriate shocks compared with those with single-chamber (SC) devices, with no difference in all-cause mortality between the two groups.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDespite its lifesaving potential, ICD therapy remains complicated by inappropriate therapies and shocks that may result in pain, anxiety, depression, and proarrhythmia. Additionally, controversy still exists as to whether a SC or DC device is the most appropriate to prevent inappropriate shocks.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe Optimal Anti-tachycardia Therapy in ICD Patients Without Pacing Indications study [OPTION; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00729703\u0026amp;atom=%2Fspmdc%2F13%2F12%2F19.atom\u0022\u003ENCT00729703\u003C\/a\u003E] was designed to test the hypothesis that DC ICD therapy with specific device-based algorithms would reduce the rate of inappropriate shocks without affecting morbidity and mortality by ventricular pacing.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOPTION was a prospective, international multicenter trial that was conducted among 54 centers in nine countries in Europe and North America. It enrolled 462 patients (86% men; mean age 63 years; 77% with ischemic heart disease) for 27 months, from 2006 to 2009. Inclusion criteria were implantation of an ICD according to European Society of Cardiology\/European Heart Rhythm Association or American College of Cardiology\/American Heart Association guidelines, and left ventricular ejection fraction \u226440%.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe primary endpoints of the study were time to first inappropriate shock and percentage of patients with a combined endpoint of all-cause mortality and hospitalization for specified cardiac reasons. Secondary endpoints included occurrence of appropriate and inappropriate shocks, all-cause mortality, and hospitalizations due to cardiovascular (CV) events.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAll subjects were supplied with a DC device (Ovatio DR 6550, Sorin Group) and then randomized to undergo SC therapy (SC tachyarrhythmia detection and ventricular back-up pacing at 40 bpm; n=223) or DC therapy (featuring device-based algorithms to reduce the incidence of inappropriate shocks by DC discrimination and to minimize ventricular pacing; n=230).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAt the study end (27 months follow-up) there was a significant difference in time to first occurrence of inappropriate shock between the two groups, with a significantly lower incidence in the DC arm compared with the SC arm (4.3% vs 10.3%; HR, 2.5; 95% CI, 1.2 to 5.3; log-rank p=0.0122; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). At 12 months, the incidences were 2.6% and 7.6%, respectively.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/19\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Time to First Inappropriate Shock\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-828017683\u0022 data-figure-caption=\u0022Time to First Inappropriate Shock\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/19\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/19\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/19\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13595\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ETime to First Inappropriate Shock\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from C Kolb, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EConsidering the safety aspect, there was no significant difference in mortality and CV events between the two groups. Twenty-one and 18 patients died in the DC and SC groups, respectively, with CV events reported in 33 and 40 patients respectively. Additionally there were relatively few device-related complications overall, with atrial lead complications in 0.9% and 1.8% of patients in the DC and SC groups, respectively.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe investigators concluded that DC ICD therapy resulted in a significantly reduced incidence of inappropriate shocks compared with SC therapy, and similar rates of all-cause mortality and CV events with a low rate of atrial lead complications.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAlthough further studies may be required to confirm this benefit, the data suggest that when a lower rate of inappropriate shocks is needed, use of a DC ICD is preferable.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 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\/13\/12\/19.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_figures.js?nznq31\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznq31\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}