Atrial fibrillation history is statistically significantly associated with adverse major clinical outcomes in ICD-implanted HF patients .
Patients with AF have a higher risk of all-cause mortality , appropriate , and inappropriate ICD interventions compared with patients with no AF history .
AIMS To assess the association between atrial fibrillation ( AF ) and all-cause mortality and implantable cardioverter-defibrillators ( ICDs ) therapies  in heart failure ( HF ) patients with reduced ejection fraction and an ICD implanted .
Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial.
IMPORTANCE Using more intervals to detect ventricular tachyarrhythmias has been associated with reducing unnecessary implantable cardioverter-defibrillator ( ICD ) therapies . OBJECTIVE To determine whether using 30 of 40 intervals to detect ventricular arrhythmias ( VT ) ( long detection ) during spontaneous fast VT episodes reduces antitachycardia pacing ( ATP ) and shock delivery more than 18 of 24 intervals ( st and ard detection ) . DESIGN , SETTING , AND PARTICIPANTS R and omized , single-blind , parallel-group trial that enrolled 1902 primary and secondary prevention patients ( mean [ SD ] age , 65 [ 11 ] years ; 84 % men ; 75 % primary prevention ICD ) with ischemic and nonischemic etiology undergoing first ICD implant at 1 of 94 international centers ( March 2008-December 2010 ) . INTERVENTIONS Patients were r and omized 1:1 to programming with long- ( n = 948 ) or st and ard-detection ( n = 954 ) intervals . MAIN OUTCOMES AND MEASURES Total number of ATPs and shocks delivered for all episodes ( primary outcomes ) and inappropriate shocks , mortality , and syncopal rate ( secondary outcomes ) . RESULTS During a median follow-up of 12 months ( interquartile range , 11 - 13 ) , long-detection group had 346 delivered therapies ( 42 therapies per 100 person-years , 95 % CI , 38 - 47 ) vs 557 in the st and ard-detection group ( 67 therapies per 100 person-years [ 95 % CI , 62 - 73 ] ; incident rate ratio [ IRR ] , 0.63 [ 95 % CI , 0.51 - 0.78 ] ; P < .001 ) . The long- vs the st and ard-detection group experienced 23 ATPs per 100 person-years ( 95 % CI , 20 - 27 ) vs 37 ATPs per 100 person-years ( 95 % CI , 33 - 41 ; IRR , 0.58 [ 95 % CI , 0.47 - 0.72 ] ; P < .001 ) ; 19 shocks per 100 person-years ( 95 % CI , 16 - 22 ) vs 30 shocks per 100 person-years ( 95 % CI , 26 - 34 ; IRR , 0.77 [ 95 % CI , 0.59 - 1.01 ] ; P = .06 ) , with a significant difference in the probability of therapy occurrence ( P < .001 ) ; and a reduction in first occurrence of inappropriate shock ( 5.1 per 100 patient-years [ 95 % CI , 3.7 - 6.9 ] vs 11.6 [ 95 % CI , 9.4 - 14.1 ] ; IRR , 0.55 [ 95 % CI , 0.36 - 0.85 ] ; P = .008 ) . Mortality ( 5.5 [ 95 % CI , 4.0 - 7.2 ] vs 6.3 [ 95 % CI , 4.8 - 8.2 ] per 100 patient-years ; HR , 0.87 ; P = .50 ) and arrhythmic syncope rates ( 3.1 [ 95 % CI , 2.6 - 4.6 ] vs 1.9 [ 95 % CI , 1.1 - 3.1 ] per 100 patient-years ; IRR , 1.60 [ 95 % CI , 0.76 - 3.41 ] ; P = .22 ) did not differ significantly between groups . CONCLUSIONS AND RELEVANCE Among patients receiving an ICD , the use of a long- vs st and ard-detection interval result ed in a lower rate of ATP and shocks , and inappropriate shocks . This programming strategy may be an appropriate alternative . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00617175
Atrial fibrillation history is statistically significantly associated with adverse major clinical outcomes in ICD-implanted HF patients .
Patients with AF have a higher risk of all-cause mortality , appropriate , and inappropriate ICD interventions compared with patients with no AF history .
AIMS To assess the association between atrial fibrillation ( AF ) and all-cause mortality and implantable cardioverter-defibrillators ( ICDs ) therapies  in heart failure ( HF ) patients with reduced ejection fraction and an ICD implanted .