Clinical Predictors of Transvenous Defibrillation Energy Requirements

Khalighi, Koroush; Daly, Barry; Leino, Eeva; Shorofsky, Stephen R.; Kavesh, Neal G.; Peters, Robert W.; Gold, Michael R.

doi:10.1016/s0002-9149(96)00702-3

Cited by 54 publications

(35 citation statements)

References 22 publications

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“…14,15 Therefore, it is even more important to predict an increase in DFT before ICD implantation in patients with HCM. Previous studies have described several clinical factors that are associated with a high DFT, such as LV dilatation, 16 body size, 16 decreased LV ejection fraction, 17 administration of antiarrhythmic drugs (class I; flecainide, 18 mexiletine 19,20 etc, class III; amiodarone [21][22][23] ), myocardial ischemia, 24-27 the ventricular fibrillation duration, 28,29 and LV mass. 23,30,31 Among these factors possibly associated with high DFTs, only the LV ejection fraction was found to be a univariate predictor of a high DFT in the present study.…”

Section: Discussionmentioning

confidence: 99%

QRS Prolongation is Associated With High Defibrillation Thresholds During Cardioverter-Defibrillator Implantations in Patients With Hypertrophic Cardiomyopathy

Nagai

Kurita

Sato

et al. 2009

Circ J

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subgroup of patients with hypertrophic cardiomyopathy (HCM) is at a high risk of having ventricular tachycardia and/or ventricular fibrillation. The implantable cardioverter-defibrillator (ICD) is widely recognized as the most effective and essential therapy for this patient population. [1][2][3] It has been demonstrated that both appropriate and inappropriate ICD discharges are frequently observed in HCM patients, 1-3 and this might impair qualityof-life as well as reduce battery longevity. Class III antiarrhythmic agents such as amiodarone have the potential for reducing ICD shocks 4 and might improve patients' prognosis. Furthermore, class I agents are also used in HCM patients to control atrial fibrillation or reduce the pressure gradient in the left ventricular (LV) outflow tract or midventricle when an obstruction is present. [5][6][7] The combined use of antiarrhythmic agents and an ICD in patients with HCM, and the larger volume of myocardium (caused by hypertrophy of the left ventricle) might result in a high defibrillation threshold (DFT). However, the predictors of a high DFT in patients with HCM have not been fully characterized. Thus, the purpose of this retrospective study was to evaluate the factors causing a high DFT in patients with HCM and ventricular tachycardia/ventricular fibrillation. Methods Study SubjectsThe study population consisted of 23 consecutive patients with an established diagnosis of HCM who underwent initial implantation of an ICD with a standard transvenous lead system at the National Cardiovascular Center from 1997 through to 2005. ICDs were implanted for secondary prevention in 20 of 23 patients, defined by clinical sustained ventricular tachyarrhythmia or resuscitation from sudden cardiac death. HCM was diagnosed on the basis of echocardiographic criteria defined as the presence of LV hypertrophy in the absence of other causes of hypertrophy. These patients also met the definition and classification proposed by the 1995 World Health Organization/International Society and Federation of Cardiology Task Force. 8 All defibrillation leads were implanted by a left cephalic vein cutdown and positioned in the right ventricular apex. No patient had any prior pacemaker implantation, and 2 had permanent atrial fibrillation. Patients who were diagnosed with HCM who progressed to a dilated phase of HCM were excluded from the study. ICD Implantation and DFT TestingThe following ICD models were implanted: 7220C (n= 1), 7223Cx (n=6), 7227Cx (n=2), 7229Cx (n=5), 7271Cx (n=1), and 7273Cx (n=5), manufactured by Medtronic, Inc (Minneapolis, MN, USA); and the 1861 (n=3) manufac- QRS Prolongation is Associated With High Defibrillation Thresholds During Cardioverter-Defibrillator Implantations in Patients With Hypertrophic CardiomyopathyTakayuki Nagai, MD; Takashi Kurita, MD; Kazuhiro Satomi, MD; Takashi Noda, MD; Hideo Okamura, MD; Wataru Shimizu, MD; Kazuhiro Suyama, MD; Naohiko Aihara, MD; Junjiro Kobayashi, MD*; Shiro Kamakura, MD Background: Although high defibrillation threshold (DFT) is a...

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Section: Discussionmentioning

confidence: 99%

QRS Prolongation is Associated With High Defibrillation Thresholds During Cardioverter-Defibrillator Implantations in Patients With Hypertrophic Cardiomyopathy

Nagai

Kurita

Sato

et al. 2009

Circ J

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“…[18][19][20][21][22][23][24][25]27,28 System revisions may include moving the right ventricular coil, inactivating or activating the superior vena cava coil, adding an extra superior vena cava, azygous or subcutaneous 40 and certain drugs, such as amiodarone. 20,31,32,[41][42][43][44] However, the strengths of these associations are not consistent and vary between studies, with some studies demonstrating no good clinical correlates of high DFTs. 41,45 Because there is no way to reliably predict which patients will have a high DFT at implant, testing is still recommended.…”

Section: Discovery Of High Dfts Needing Systemmentioning

confidence: 99%

Is Defibrillation Testing Necessary for Implantable Transvenous Defibrillators?

Russo

Chung²

2014

Circ: Arrhythmia and Electrophysiology

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“…Amiodarone use, nephropathy, low left ventricular ejection fraction, and supraventricular tachycardia are independent predictors of cardiac death (Worck, 2007). One can speculate that proarrhythmia and/or increased defibrillation thresholds could play a role in the association with increased mortality (Khalighi, 1997;Zhou, 1998). In addition, amiodarone harmfully affected survival in NYHA III patients in the SCD-HeFT (Bardy, 2005).…”

Section: Medical Therapymentioning

confidence: 99%