Adherence to consensus-based implantable cardioverter-defibrillator programming and impact on therapy delivery in clinical practice: A national cohort study

Implantable cardioverter-defibrillator programming in Italy shifted toward evidence-based high-rate detection strategies after 2020, closely following manufacturer updates to nominal device settings, although overall adoption remained modest, reaching 15% by 2023. Programming consistent with the high-rate strategy was associated with significantly fewer therapies, including both antitachycardia pacing and shocks, confirming in real-world practice the benefits previously demonstrated in randomized trials and registries. Reprogramming during follow-up was rare, indicating that initial programming choices largely persisted over time and highlighting the need for more systematic use of remote monitoring to promote guidelinedirected optimization.