Published Online
on December 18, 2006

A more recent version of this article appeared on January 2, 2007

This Article Full Text (PDF) CME: Take the course for this article: Circulation: January 2/9, 2007, Volume 115, Number 1 Data Supplement All Versions of this Article: 115/1/9    most recent CIRCULATIONAHA.106.629428v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Olshansky, B. Articles by Lerew, D. R. Search for Related Content PubMed PubMed Citation Articles by Olshansky, B. Articles by Lerew, D. R. Related Collections Electrophysiology Pacemaker Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

Submitted on March 29, 2006
Accepted on October 20, 2006

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, and 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.

^* To whom correspondence should be addressed. E-mail: brian-olshansky{at}uiowa.edu.

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.

Key words: arrhythmia • tachyarrhythmias • defibrillation • electrophysiology • pacing

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