Clinical impact of defibrillation testing at the time of implantable cardioverter-defibrillator insertion

Hadid, Claudio; Atienza, Felipe; Strasberg, Boris; Arenal, Ángel; Codner, Pablo; González‐Torrecilla, Esteban; Datino, Tomás; Percal, Tamara; Almendral, Jesús; Ortiz, Mercedes; Martins, Raphaël P.; Martínez-Alzamora, Nieves; Fernández‐Avilés, Francisco

doi:10.5603/cj.a2014.0062

Cited by 1 publication

(1 citation statement)

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“…Our results are consistent with previous observational data [12][13][14][15][16][17][18][19][20][21][22] and meta-analyses [5,23] and provide further support to the recommendation to omit defibrillation efficacy testing in patients undergoing initial transvenous ICD implantation procedures [24]. Nonetheless, these results do not apply to specific subgroups, which were excluded or poorly represented in this meta-analysis, such as patients with right-sided ICD pocket or non-transvenous systems; patients with congenital heart diseases, channelopathies or hypertrophic cardiomyopathy; and patients who undergo device replacement.…”

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confidence: 83%

Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation

Bonanno

Rossillo

Paccanaro

et al. 2017

ijcp

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Introduction: There is an ongoing debate regarding the need to conduct intraoperative defibrillation testing (DFT) at the time of implantable cardioverter-defibrillator (ICD) implantation. To provide sufficiently strong evidence for the feasibility of omitting intraoperative DFT in clinical practice, we conducted a meta-analysis of randomized controlled trials (RCT) comparing patients with DFT and no-DFT. Methods: We systematically searched Medline (via PubMed), ClinicalTrial.gov, the Cochrane Central Register of Controlled Trials, and Embase for studies evaluating DFT vs. no-DFT on ICD implantation with regard to total mortality and arrhythmic death, efficacy of first and any appropriate shock in interrupting ventricular tachycardia (VT)/ ventricular fibrillation (VF), and procedural adverse events. Effect estimates [risk ratio (RR) with 95% confidence intervals (CI)] were pooled using the random-effects model. Results: Our meta-analysis included 4 RCTs comprising 3770 patients (1896 with DFT and 1874 without DFT). Total mortality (RR = 1.00, 95% CI 0.86-1.17; P = 0.98) and arrhythmic death (RR = 1.60, 95% CI 0.46-5.59: P = 0.46) were not statistically different. Both first (RR = 0.94, 95% CI 0.89-0.98; P = 0.004) and any appropriate ICD shock (RR = 0.97, 95% CI 0.95-1.00; P = 0.02) significantly increased the rate of VT/VF interruption in the group with no-DFT in comparison with DFT. Finally, the incidence of adverse events was lower in no-DFT patients (RR = 1.23; 95% CI 1.00-1.51; P = 0.05). Conclusions:The practice of DFT (as opposed to no-DFT) did not yield benefits in mortality or the overall rate of conversion of VT/VT. Moreover, a slightly higher incidence of perioperative adverse events was observed in the DFT group.

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