Table 1: Strategies to Reduce Implantable Cardioverter Defibrillator Therapies and Their Effect on Mortality.
| Strategy to Reduce Implantable Cardioverter Defibrillator Shocks | Impact on Shock Reduction | Mortality Impact |
|---|---|---|
| Strategic ICD programming | 50 % reduction in inappropriate therapy No difference in appropriate shocks | 30 % reduction in mortality |
| Remote monitoring | ECOST RCT: 71 % reduction in all shocks and 52 % reduction in inappropriate shocks from the ECOST trial | No difference in mortality |
| IN-TIME RCT 1-year results: Shock occurrence not reported | Reduction in all-cause mortality (HR 0.36) | |
| Unclear impact of reduced shocks on mortality in both trials | ||
| Antiarrhythmic drugs | 48 % reduction in combined endpoint of mortality and first shock at 1-year with sotalol in RCT | No difference in mortality between sotalol versus placebo |
| OPTIC RCT 1-year results: amiodarone plus β-blocker versus β-blocker (HR 0.27). Amiodarone plus β-blocker versus sotalol (HR 0.43) | No difference in mortality between groups | |
| Catheter ablation | SMASH-VT RCT 2-year results: Reduction of appropriate therapy (HR 0.35) | No difference in mortality |
| VTACH RCT 2-year results: Higher freedom from VT/VF (HR 0.61) | No difference in mortality |
ICD = implantable cardioverter defibrillator; ECOST = Effectiveness and Cost of ICDs Follow-up Schedule with Telecardiology; IN-TIME = The Influence of Home Monitoring on the Clinical Status of Heart Failure Patients With Impaired Left Ventricular Function; OPTIC = Optimal Pharmacological Therapy in Implantable Cardioverter Defibrillator Patients; RCT = randomised controlled trial; SMASH-VT = Substrate Mapping and Ablation in Sinus rhythm to Halt Ventricular Tachycardia; VF = ventricular fibrillation; VT = ventricular tachycardia; VTACH = Ventricular Tachycardia Ablation in Addition to Implantable Defibrillators in Coronary Heart Disease.