Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial
Open accessAbstract
Background—: The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery in these patients is unknown. Methods and Results—: The Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy (MADIT-RIT) randomized patients with a primary prophylactic ICD indication to 3 different types of ICD programming: conventional programming with a ventricular tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative ICD programming reduced the risk of inappropriate therapy regardless of diabetes mellitus, although a trend toward a more pronounced effect of high-rate cutoff programming was seen in patients without diabetes mellitus ( P for interaction=0.06). Diabetes mellitus was associated with a decreased risk of inappropriate therapy (hazard ratio, 0.54; 95% confidence interval, 0.36–0.80; P =0.002) and increased risk of appropriate therapy (hazard ratio, 1.58; 95% confidence interval, 1.17–2.14; P =0.003). In diabetic patients, there was significantly increased risk of death in those who had inappropriate therapy (hazard ratio, 4.17; 95% confidence interval, 1.52–11.40; P =0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06–5.87; P =0.037) compared with those who did not. Conclusions—: Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate therapy in patients with and without diabetes mellitus. Diabetes mellitus was associated with lower risk of inappropriate therapy but higher risk of appropriate therapy. Appropriate and inappropriate ICD therapy was associated with increased mortality in diabetic patients. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00947310.
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Observational studies have reported significant corrected QT interval prolongation possibly associated with microvascular complications, atypical patterns of microvolt T-wave alternans, altered heart rate variability, or heart rate turbulence in patients with diabetes.
“Observational studies have reported significant corrected QT (QTc) interval prolongation possibly associated with microvascular complications, atypical patterns of microvolt T-wave alternans, altered heart rate variability, or heart rate turbulence in patients with diabetes, but none of these tests should routinely be used to stratify the risk of ventricular arrhythmias or SCD in clinical practice”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [661]
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2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., Ajjan, R. A., Antunes, M. J., Christodorescu, R. M., Crawford, C., Di Angelantonio, E., Eliasson, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad192 · Cited by 1,642 · see citing works
- Authors
- Ruwald, M. H., Zareba, W., Jons, C., Zhang, C., Ruwald, A.-C. H., Olshansky, B., McNitt, S., Bloch Thomsen, P. E., Shoda, M., Merkely, B., Moss, A. J., & Kutyifa, V.
- Affiliations
- Semmelweis University (HU)
- From the Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., W.Z., C.Z., A.-C.H.R., S.M., A.J.M., V.K.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., C.J., A.-C.H.R.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); Faculty of Medicine, University of Aalborg, Aalborg, Denmark (P.E.B.T.); Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan (M.S.); and Heart Center, Semmelweis...
- ORCID
- Venue
- Circulation
- Published
- 2013-08-13
- Volume
- 128
- Issue
- 7
- Pages
- 694-701
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2122209221
- Cited by
- 30
- References
- 40
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 4
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- University of Rochester
- Boston Scientific Corporation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- diabetes mellitus, implantable cardioverter-defibrillator, inappropriate ICD therapy, appropriate ICD therapy, ICD programming, ventricular tachycardia detection, mortality, prophylactic ICD, cardiac resynchronization therapy, ventricular arrhythmias
- MeSH terms
- Aged, Algorithms, Arrhythmias, Cardiac, Electric Countershock, Equipment Failure, Female, Follow-Up Studies, Humans, Male, Middle Aged, Models, Cardiovascular, Risk, Proportional Hazards Models, Single-Blind Method, Defibrillators, Implantable, Tachycardia, Ventricular, Unnecessary Procedures, Diabetes Complications, Kaplan-Meier Estimate, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy Devices
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