Complications associated with defibrillation threshold testing: The Canadian experience

Birnie, David H.; Tung, Stanley; Simpson, Christopher S.; Crystal, Eugene; Exner, Derek V.; Ayala‐Paredes, F.; Krahn, Andrew D.; Parkash, Ratika; Khaykin, Yaariv; Philippon, François; Guerra, Peter G.; Kimber, Shane; Cameron, Douglas; Healey, Jeffrey S.

doi:10.1016/j.hrthm.2007.11.018

Cited by 158 publications

(127 citation statements)

References 13 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…16) From a survey of 21 adult ICD implant centers, Birnie, et al reported the occurrence of 3 DFTrelated deaths, 5 DFT testing-related strokes, and 27 episodes requiring prolonged resuscitation over a period of 6.75 years. 13) In 2008, Poole, et al reported an increased risk of death for patients, regardless of whether they received appropriate or inappropriate ICD shocks, 17) and since that time, a reduction in the shock delivery burden has been recommended. Blatt, et al investigated whether DFT testing during ICD implantation predicts clinical outcomes and found no difference in shock efficacy or long-term mortality between their low DFT group (< 10 J) and high DFT group (> 10 J).…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11] Induction of ventricular fibrillation (VF) during DFT can cause hemodynamic compromise, clinical deterioration, and life-threatening cerebrovascular accidents. [12][13][14][15] Thus, we conducted a retrospective study to assess the effect of DFT testing on long-term outcomes in patients with an ICD or cardiac resynchronization therapy defibrillator (CRT-D).…”

Section: Mplantable Cardioverter-defibrillators (Icds) Have Beenmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Efficacy and Necessity of Routine Defibrillation Threshold Testing in Patients Undergoing Implantable Cardioverter-Defibrillator (ICD) Implantation

et al. 2015

View full text Add to dashboard Cite

SummaryDefibrillation threshold (DFT) testing is performed routinely in patients undergoing implantable cardioverter-defibrillator (ICD) implantation to verify the ability of the ICD to terminate ventricular fibrillation (VF). However, neither the efficacy nor the safety of DFT testing has been proven; thus, the necessity of such testing is controversial. We conducted a retrospective study of the efficacy of DFT testing, particularly with respect to long-term outcomes of ICD implantation.The study included 150 patients (125 men, 25 women, aged 59.0 ± 17.6 years) who underwent ICD or cardiac resynchronization therapy defibrillator implantation, with (n = 73) or without (n = 77) intraoperative DFT testing, between June 1996 and September 2007. VF was induced by delivery of a T-wave shock, and a 20-25-J shock was then delivered. If the 20-25-J shock failed to terminate VF, 30 J was delivered. We assessed whether undersensed VF events occurred during DFT testing and/or during patient follow-up and checked for any association between undersensing and delayed shock delivery. During DFT testing, fine VF was sensed, and shocks were delivered in a timely manner. Nevertheless, 2 patients in the DFT testing group died from VF within 3 years after device implantation.DFT testing, in comparison to non-DFT testing, appeared to have no influence on the long-term outcomes of our patients, suggesting that DFT testing at the time of ICD implantation is limited. (Int Heart J 2015; 56: 618-621) Key words: Ventricular arrhythmia, Mortality I mplantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality resulting from both ischemic 1,2) and non-ischemic cardiomyopathies 2) and to terminate potentially fatal ventricular arrhythmias.3,4) Current indications for an ICD include not only a near-fatal arrhythmic event 5) and ischemic cardiomyopathy but also severe nonischemic cardiomyopathy with a low left ventricular ejection fraction (LVEF).Defibrillation threshold (DFT) testing during ICD implantation has been considered necessary for appropriate shock delivery, 6) and a DFT safety margin of 10 J is the standard recommendation.6,7) However, neither the efficacy nor benefit of DFT testing has been proven. [8][9][10][11] Induction of ventricular fibrillation (VF) during DFT can cause hemodynamic compromise, clinical deterioration, and life-threatening cerebrovascular accidents.12-15) Thus, we conducted a retrospective study to assess the effect of DFT testing on long-term outcomes in patients with an ICD or cardiac resynchronization therapy defibrillator (CRT-D). MethodsStudy patients: The study included 150 patients (125 men, 25 women) who received an ICD (n = 85) or CRT-D (n = 65) at our hospital between June 1996 and September 2007. Hospital records were obtained, from which we extracted the patient clinical characteristics, follow-up times, ICD intracardiac recordings, and clinical outcomes. The ICDs and CRT-Ds were implanted in a standard transvenous manner. We divided the patients into 2 groups, those in whom DFT...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Mplantable Cardioverter-defibrillators (Icds) Have Beenmentioning

confidence: 99%

Assessment of Efficacy and Necessity of Routine Defibrillation Threshold Testing in Patients Undergoing Implantable Cardioverter-Defibrillator (ICD) Implantation

et al. 2015

View full text Add to dashboard Cite

show abstract

“…However, this strategy is currently being questioned due to the high probability of current devices to successfully defibrillate ventricular arrhythmias, the low incidence of spontaneous ventricular fibrillation (VF) (~10%) and the high efficacy of dedicated antitachycardia pacing (ATP) strategies [2][3][4][5][6][7][8]. Moreover, defibrillation testing (DT) is not without a risk, and complications associated to VF induction, shock delivery and anesthesia may occur [2,3,[9][10][11][12]. For all these reasons, the proportion of patients undergoing any type of DT, especially among primary prevention ICD implantation, is experiencing a progressive decline in routine clinical practice [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

View full text Add to dashboard Cite

show abstract

“…As a result, the need for routine DFT testing at implantation has been reconsidered. 22, 23 Randomized trials have now shown that left-sided ICD implantation without DFT testing is non-inferior to implantation with DFT testing. 22, 24 In addition, shock therapy may adversely affect prognosis, whether appropriate or inappropriate, although controversy persists as to whether that reflects a greater degree of underlying illness or a primary shock effect.…”

Section: Discussionmentioning

confidence: 99%

Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy

Okamura

Friedman

Inoue

et al. 2016

Circ J

View full text Add to dashboard Cite

Complications associated with defibrillation threshold testing: The Canadian experience

Cited by 158 publications

References 13 publications

Assessment of Efficacy and Necessity of Routine Defibrillation Threshold Testing in Patients Undergoing Implantable Cardioverter-Defibrillator (ICD) Implantation

Assessment of Efficacy and Necessity of Routine Defibrillation Threshold Testing in Patients Undergoing Implantable Cardioverter-Defibrillator (ICD) Implantation

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

Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy

Contact Info

Product

Resources

About