[Inadequate therapies with implantable cardioverter-defibrillators--incidence, etiology, predictive factors and preventive strategies].

Patients with implantable cardioverter defibrillators (ICD) often suffer inappropriate ICD-therapies. The incidence, causes and risk factors of ICD-therapies for a rhythm other than ventricular tachyarrhythmias (VT) were determined retrospectively in 462 consecutive patients (pts). Inappropriate ICD-therapies were identified based on stored R-R intervals and/or electrograms. Eighty-two pts (18%) had inappropriate ICD-therapies. Actuarial rates for inappropriate ICD-therapies were 13%, 20%, 24% and 29% at 1, 2, 3 and 4 years after ICD-implantation, respectively. Atrial fibrillation with rapid ventricular response was the most common cause (34 pts, 39%). In 26 pts (30%), sinus tachycardia triggered inappropriate ICD-therapies, in 21 pts (24%) overseeing, mostly due to fractures and insulation failures of the leads, in three pts atrial flutter, in two pts non-sustained VT, in one pt supra-ventricular tachycardia and in another pt T-wave double sensing caused inappropriate ICD-therapies. In order to prevent recurrences of inappropriate ICD-therapies due to atrial fibrillation or sinus tachycardia, a rate stability (n = 19) or onset (n = 15) criterion was programmed, 41 pts additionally received beta-blocking agents and/or digoxin. In pts with overseeing an operative revision of lead system was performed. During further follow-up (15 +/- 13 months), 15 pts had recurrences of inappropriate ICD-therapies (eight pts due to atrial fibrillation, three due to sinus tachycardia and four due to overseeing). On multivariate analysis (Cox regression), history of atrial fibrillation, maximum heart rate during exercise and low cut-off rate for VT-detection were predictors of inappropriate ICD-therapies. Thus, inappropriate ICD-therapies are frequent, especially in the first year after implantation. Additional detection criteria, beta-blocking agents and/or digoxin prevent recurrences in most patients. In patients with a history of atrial fibrillation, high heart rate during exercise or a low cut-off rate for VT-detection, activation of additional detection criteria should be considered directly after ICD-implantation.