Findings from a new multicentre, randomized, controlled trial—known as ADVANCE III—indicate that programming implantable cardioverter–defibrillators (ICDs) with a long detection time (30 of 40 intervals) might be beneficial for ICD recipients.

The ADVANCE III investigators explain that their long-detection programme, which results in delays in ICD recognition of arrhythmia, “was applied to allow nonsustained events to self-terminate, thus avoiding unnecessary therapies”. The long-detection programme was compared with a standard-detection programme (18 of 24 intervals) in 1,902 patients with primary or secondary indications for an ICD. Median follow-up was 12 months.

Long detection was associated with a significantly lower incidence of ICD therapies (antitachycardia pacing or shock) compared with standard-interval detection (incidence rate ratio [IRR] 0.63, 95% CI 0.51–0.78, P <0.001). Although the incidence of appropriate shocks was similar between the two groups, the incidence of inappropriate shocks was significantly lower with long detection (IRR 0.55, 95% CI 0.36–0.85, P = 0.008).

Quality of life did not differ between the long-detection and standard-detection groups, but long detection was associated with a lower rate of hospitalization (IRR 0.81, 95% CI 0.68–0.98, P = 0.03). Rates of arrhythmic syncope and death did not significantly differ between the two groups.

“Our results confirmed and reinforced, in a larger population, the main results recently presented by the MADIT-RIT trial”, say the ADVANCE III investigators.