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(Circulation. 2007;115:9-16.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Is Dual-Chamber Programming Inferior to Single-Chamber Programming in an Implantable Cardioverter-Defibrillator?

Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) Study

Brian Olshansky, MD; John D. Day, MD; Stephen Moore, DO; Lawrence Gering, MD; Murray Rosenbaum, MD; Maureen McGuire, PhD; Scott Brown, PhD; Darin R. Lerew, PhD

From University of Iowa Hospitals (B.O.), Iowa City, Iowa; Utah Heart Clinic Arrhythmia Service (J.D.D.), LDS Hospital, Salt Lake City, Utah; North Ohio Research, Ltd (S.M.), Elyria, Ohio; Owensboro Mercy Health System, Owensboro, Ky, and Riverview Hospital, Noblesville, Ind (L.G.); Cardiac Arrhythmia Service (M.R.), Ft. Lauderdale, Fla; Boston Scientific CRM (M.M., D.R.L.), St. Paul, Minn; and The Integra Group (S.B.), Brooklyn Park, Minn.

Reprint requests to Brian Olshansky, MD, Director, Cardiac Electrophysiology, University of Iowa Hospitals, 200 Hawkins Dr, Iowa City, IA 52242. E-mail brian-olshansky{at}uiowa.edu

Received March 29, 2006; accepted October 20, 2006.

Background— The INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AVSH in ICDs) study tested the hypothesis that dual-chamber rate-responsive (DDDR) with atrioventricular search hysteresis (AVSH) 60-130 programming is not inferior to single-chamber (VVI)–40 programming in an implantable cardioverter defibrillator with respect to all-cause mortality and heart failure hospitalizations using an equivalence margin of 5%.

Methods and Results— At 108 centers, 1530 patients with an implantable cardioverter defibrillator indication received a VITALITY AVT (Guidant Corporation, St. Paul, Minn) implantable cardioverter defibrillator programmed consistently to DDDR AVSH 60-130 for the first week. Of those, 988 patients with <20% right ventricular pacing at 1 week were randomized to DDDR AVSH 60-130 or to VVI-40 programming. Among those randomized, 502 were assigned to DDDR AVSH and 486 to VVI. Groups were similar with regard to coronary disease (68%), gender (21% female), and New York Heart Association functional class >I (79%). A total of 32 patients (6.4%) in the DDDR AVSH arm and 46 patients (9.5%) in the VVI arm died or were hospitalized for heart failure during a mean follow-up of 10.4 months (relative risk=0.67, P=0.072 in favor of DDDR AVSH). DDDR AVSH was not inferior to VVI programming (P<0.001). All-cause mortality was not significantly different between the DDDR AVSH arm (3.6%) and the VVI arm (5.1%; P=0.23). The mean percent right ventricular pacing in the DDDR AVSH arm was 10% (median 4%) versus 3% (median 0%) in the VVI arm.

Conclusions— In the INTRINSIC RV trial, among those randomized, DDDR AVSH was associated with similar outcomes as with VVI backup pacing.

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