Abstract 9896: Reassessing Risk Factors for High Defibrillation Threshold: The EF-SAGA Risk Score and Implications for Device Testing

Abstract

Background: Controversy exists over routine defibrillation threshold (DFT) testing during implantable cardioverter-defibrillator (ICD) placement. The aim of this study was to reevaluate risk factors for high DFT and propose a risk assessment tool. Methods: We retrospectively analyzed 1642 consecutive patients who received an ICD and underwent DFT testing. Results: The incidence of high DFT requiring addition of a subcutaneous array was 2.3%. Five significant independent variables predictive of high DFT were identified including younger age, male gender (hazard ratio 1.99), LV dysfunction, secondary prevention (hazard ratio 2.33), and amiodarone use (hazard ratio 2.39). Each 10 year increase in age was indicative of a 0.35 times lower chance of high DFT. Each 10% increase of LV EF was indicative of a 0.52 times lower chance of high DFT. These five variables form the EF-SAGA risk score (LV EF less than 20%, Secondary prevention ICD indication, Age less than 60 years, male Gender, Amiodarone use). Cumulative risk of high DFT increased incrementally; patients with four or more variables had an 8.9% likelihood of high DFT (Figure 1). Importantly, primary prevention patients with LV EF >20% had a negative predictive value for high DFT of 99.3%. Conclusions: In conclusion, we identified five independent predictors of high DFT. We propose the EF-SAGA risk score to help decision making. Primary prevention patients with an LV EF >20% had an exceedingly low incidence of high DFT suggesting that testing could be avoided in these patients. Careful assessment of the risk-benefit ratio of testing is important in high-risk patients.