First multi-centre evaluation of a knowledge-based implant-assistant for implantable cardioverter-defibrillators.

AIMS Modern implantable cardioverter-defibrillators (ICDs) place increasing demands on the physician, as their complexity requires more and more knowledge and effort in handling them. To overcome this problem an implant-assistant has been developed, which transfers clinical data entered by the physician into a complete set of parameters for programming a dual-chamber ICD (Tachos-DR, Biotronik, Berlin, Germany) at DFT testing (DFT-Prog) and first permanent programming (Perm-Prog) after implant. METHODS AND RESULTS Routine ICD implantations were initially evaluated by clinical experts at 19 centres in USA and Europe from 178 patient files. The rating of parameters was related to the number of parameters available in each patient. For DFT-Prog, 98.4% of parameter suggestions were identical to experts' expectations, an additional 1.0% were accepted, 0.5% were rejected, and none was considered harmful. This resulted in an overall acceptance of 94.4% of the DFT-Prog. For Perm-Prog, 96.1% of parameters were identical to those advised by experts, an additional 2.4% were accepted, 1.5% rejected, and seven parameters (0.04%) were considered potentially harmful by experts with an overall acceptance of 86.5%. Adaptation of the implant-assistant increased the overall acceptance to 100% for DFT-Prog and 90.6% for first Perm-Prog without any potentially harmful suggestions. CONCLUSION The ICD implant-assistant, which allows the physician to programme ICDs directly from clinical data, is a promising method to simplify the programming of modern ICDs.