Shock Reduction Clinical Evidence

Shock Reduction History

Watch James Coles, PhD, review Medtronic’s history of Shock Reduction in this brief video.

Starting with the GEM DR study in 1997, Medtronic has enrolled more than 15,000 patients in numerous prospective clinical trials focused on the three pillars of inappropriate or unnecessary shock reduction: Painless (non-shock) therapies, optimal device programming, and arrhythmia sensing and detection algorithms.

The results of these trials were published in key cardiology journals.

Collectively, these publications capture the evolution of shock reduction strategies which led to the state-of-the-art shock reduction therapies, programming and algorithms in current Medtronic ICDs.

Painless Therapies: The Evolution of Anti-Tachycardia Pacing (ATP) in ICDs

Device Programming: How Device Programming Has Evolved

Sensing and Detection Algorithms: The Path to Algorithm Enhancement


Wathen MS, Sweeney MO, DeGroot PJ, et al. Shock reduction using antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with coronary artery disease. Circulation. 2001;104:796-801.
Wathen MS, DeGroot PJ, Sweeney MO, et al, for the PainFREE Rx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation. 2004;110:2591-2596.
Santini M, Lunati, M, Defaye P, et al. Prospective multicenter randomized trial of fast ventricular tachycardia termination by prolonged versus conventional anti-tachyarrhythmia burst pacing in implantable cardioverter-defibrillator patients-Atp DeliVery for pAiNless ICD thErapy (ADVANCE-D) Trial results. J Interv Card Electrophysiol 2010;27:127–135.
Gasparini M, Anselme F Clementy F, et al. BIVentricular versus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D Trial. Am Heart J. 2010;159:1116-1123.
Schoels W, Steinhaus D, Johnson  et al. Optimizing implantable cardioverter-defibrillator treatment of rapid ventricular tachycardia: antitachycardia pacing therapy during charging. Heart Rhythm 2007;4:879–885.
Wilkoff B, Ousdigian KT, Sterns LD, et al. A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter EMPIRIC trial. J Am Coll Cardiol 2006;48:330–339.
Wilkoff B, Williamson BD, Stern RS, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol 2008;52:541–550.
Gasparini M, Menozzi C, Proclemer A, et al. A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study. European Heart Journal 2009;30:2758–2767.
Gasparini M, Proclemer A, Klersy C, et al. 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. JAMA 2013;309:1903-1911.
10 Silver MT, Sterns LD, Piccini JP, et al. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks. Heart Rhythm. 2015;12:545-53.
11 Wilkoff BL, Kuhlkamp V, Volosin K, et al. Critical analysis of dual-chamber implantable cardioverter-defibrillator arrhythmia detection : results and technical considerations. Circulation 2001;103;381-386.
12Klein GJ, Gillberg JM, TangA, et al. Improving SVT discrimination in single-chamber ICDs: a new electrogram morphology-based algorithm. J Cardiovasc Electrophysiol 2006;17:1310-1319.
13 Auricchio A, Schloss EJ, Kurita T, et al. Low inappropriate shock rates in patients with single and dual/triple chamber ICDs using a novel suite of detection algorithms: PainFree SST Trial Primary Results. Heart Rhythm. 2015;12:926-36.


Last updated: 
12 Sep 2016