Five-Year Experience with Implantation and Follow-Up of Transvenous Implantable Cardioverter Defibrillators: Placing Postimplant Defibrillation Threshold Testing in Perspective

Roman-Gonzalez, Javier; Shapiro, Michael L.; Rubal, Bernard J.; Bulgrin, James R.; Muse, Roger J.

doi:10.1093/milmed/166.6.500

Cited by 4 publications

(10 citation statements)

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“…Most test protocols include the step‐down technique 3,12–14,16,20 . In some protocols, the DFT was the endpoint for testing, in others a sufficient safety margin 21–25 .…”

Section: Discussionmentioning

confidence: 99%

“…In 14 studies of intra‐ and postoperative testing (six prospective and eight retrospective), the reported postoperative testing failure rates were 0%–6.7% concerning important findings during the DFT measurement and an overall failure rate of up to 8.0%. Nine of these (four prospective and five retrospective) concluded that postoperative testing was not necessary 2–4,6,7,12,13,16,20 based on successful completion of the test protocol during operation and no detection of dysfunction in basic parameters postoperatively, i.e., low R wave, high pacing threshold, or undersensing. Five studies (two prospective and three retrospective) were in favor of performing the postoperative testing 5,9–11,31 .…”

Section: Discussionmentioning

confidence: 99%

“…A successful defibrillation energy of at least 10 J below the maximum deliverable energy is a commonly used efficacy and safety endpoint for a successful implantable cardioverter‐defibrillator (ICD) implantation 1 in combination with acceptable basic pacing parameters. Many investigators do not repeat defibrillation testing before discharge following a successful intraoperative induction test 2–4 . It is a growing necessity to simplify the measurements because of the increasing number of implanted ICDs.…”

Section: Introductionmentioning

confidence: 99%

“…It is a growing necessity to simplify the measurements because of the increasing number of implanted ICDs. As yet, there is no consensus about the indication of postoperative induction tests, how they should be performed, and what would be an acceptable energy level and safety margin 2–18 . We made a retrospective study in our consecutive, single‐center ICD population.…”

Section: Introductionmentioning

confidence: 99%

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Testing the Implantable Cardioverter‐Defibrillator After Implantation—Is It Necessary?

Sandstedt

Gottfridsson

Nyström

et al. 2007

Pacing Clinical Electrophis

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The results of intraoperative and postoperative predischarge implantable cardioverter-defibrillator (ICD) testing of 211 consecutive patients, starting at 15 J and requiring two successful terminations of induced VT/VF with a relative defibrillation safety margin (DSM) of >10 J, were reviewed. The aim was to define the type of intraoperative response that would make postoperative predischarge testing unnecessary. The intraoperative responses were divided into three types: A, a DSM > or =10 J and an absolute energy level of < or =20 J; B, a DSM of > or =10 J and an absolute energy level of >20 J; and C, a DSM <10 J and an absolute energy level of >20 J. At operation, the responses to defibrillation were A, 88.6%; B, 7.1%; and C, 4.3%. Accepting an A response only would leave 11.4% of the patients for postoperative testing. The positive and negative predictive values for diagnosing a postoperative C response were 0.78 and 0.97, respectively. Similarly, the predictive values for diagnosing a postoperative B or C response were 0.71 and 0.97, respectively. The postoperative testing responses were A, 89.1%; B, 4.3%; and C, 6.6%. In summary, an intraoperative A response was sufficient to make a postoperative defibrillation testing unnecessary, while it was found that intraoperative B and C responders should undergo postoperative testing. Applying these criteria, approximately 90% of the patients could be discharged without any postoperative induction test.

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“…Most test protocols include the step‐down technique 3,12–14,16,20 . In some protocols, the DFT was the endpoint for testing, in others a sufficient safety margin 21–25 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Testing the Implantable Cardioverter‐Defibrillator After Implantation—Is It Necessary?

Sandstedt

Gottfridsson

Nyström

et al. 2007

Pacing Clinical Electrophis

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“…Individual studies had their own cutoff values for segregating high DFT vs low DFT groups with values ranging from 9 to 18 J ( Table 2). Roman-Gonzalez et al 22 is the only study that had its high DFT group labeled as those requiring DFT >25 J along with defibrillation safety margin (DSM) <10 J. Funnel plot for the analysis showed no significant publication bias among the studies ( Figure 3A). Our pooled analysis ( Figure 6) showed that patients with high DFT at testing had no significant increase in allcause mortality compared to patients with low DFT (OR 0.527; CI 0.034-8.107; P = 0.646).…”

Section: Meta-analysis Of High Dft Vs Low Dftmentioning

confidence: 94%

Routine DFT testing in patients undergoing ICD implantation does not improve mortality: A systematic review and meta‐analysis

Kannabhiran

Mustafa

Acharya

et al. 2018

Journal of Arrhythmia

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Defibrillation threshold (DFT) testing has been an integral part of implantable cardioverter‐defibrillator (ICD) implantation to confirm appropriate sensing of ventricular fibrillation and to establish an adequate safety margin for defibrillation. However, there is a lack of evidence regarding benefits of routine DFT testing. Therefore, we performed a meta‐analysis to assess its mortality benefit. We searched MEDLINE for studies comparing mortality outcomes in ICD recipients who underwent DFT testing to those who did not. For the second analysis, studies comparing outcomes in patients with high‐ vs low‐energy DFT were included. Odds ratio and standard errors were calculated, and inverse variance method in a random‐effect model was used to combine effect sizes. Fifteen studies with 10,975 subjects comparing outcomes in patients who underwent routine DFT testing during ICD implantation and those who did not were included. There was no difference in the group that did not undergo DFT testing with regards to all‐cause mortality (OR 0.935; CI 0.725‐1.207; P = 0.606), cardiac mortality (OR 0.709; CI 0.385‐1.307; P = 0.271), noncardiac mortality (OR 0.921; CI 0.701‐1.210; P = 0.554), and arrhythmic mortality (OR 1.152; CI 0.831‐1.596; P = 0.396). Percentage of successful appropriate first shocks among the two groups showed no difference. Five studies with 2278 subjects were included in the second analysis comparing patients with low DFT vs high DFT. Patients with high DFT had no significant increase in all‐cause mortality compared to patients with low DFT (OR 0.527; CI 0.034‐8.107; P = 0.646). Patients requiring higher DFT had no increased all‐cause mortality compared to patients with lower DFT. Routine DFT testing during ICD implantation does not confer any significant benefit.

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Effect of defibrillation testing on management during implantable cardioverter-defibrillator implantation

Leong‐Sit

Gula

Diamantouros

et al. 2006

American Heart Journal

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Five-Year Experience with Implantation and Follow-Up of Transvenous Implantable Cardioverter Defibrillators: Placing Postimplant Defibrillation Threshold Testing in Perspective

Cited by 4 publications

References 0 publications

Testing the Implantable Cardioverter‐Defibrillator After Implantation—Is It Necessary?

Testing the Implantable Cardioverter‐Defibrillator After Implantation—Is It Necessary?

Routine DFT testing in patients undergoing ICD implantation does not improve mortality: A systematic review and meta‐analysis

Effect of defibrillation testing on management during implantable cardioverter-defibrillator implantation

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