Most patients may safely undergo inductionless or limited shock testing at ICD implantation

Day, John D.; Doshi, Rahul N.; Belott, Peter H.; Birgersdotter‐Green, Ulrika; Behboodikhah, Mahnaz; Ott, Peter; Glatter, Kathryn A.; Lee, Byron K.; Frumin, Howard; Crandall, Brian G.; Osborn, Jeffrey S.; Weiss, J. Peter; Lappé, Jason M.; Valderrábano, Miguel; Urratio, Catherine; McGuire, Maureen; Hahn, Stephen J.

doi:10.1016/j.hrthm.2005.02.109

Cited by 6 publications

(26 citation statements)

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“…These findings are consistent with our previously reported findings of a study of 194 patients who underwent device testing, in which prolonged hypotension was observed in 2% and 8% of patients after VSM and DSM screening, respectively (Pϭ0.006). 16 It has been shown that patients with advanced heart failure are more likely to have an elevated DSM. 17 In fact, this patient type trended toward a higher DSM in the present study, 3.5% for those classified as NYHA I/II versus 8.7% for those deemed NYHA III/IV (Pϭ0.0345).…”

Section: Discussionmentioning

confidence: 99%

Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators

et al. 2007

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Background-Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators have relied on multiple ventricular fibrillation (VF) induction/defibrillation tests at implantation to ensure that the device can reliably sense, detect, and convert VF. The ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations) is the first large, multicenter, prospective trial comparing vulnerability safety margin testing versus defibrillation safety margin testing with a single VF induction/defibrillation. Methods and Results-A total of 426 patients receiving an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator underwent vulnerability safety margin or defibrillation safety margin screening at 14 J in a randomized order. After this, patients underwent confirmatory testing, which required 2 VF conversions without failure at Յ21 J. Patients who passed their first 14-J and confirmatory tests, irrespective of the results of their second 14-J test, had their devices programmed to a 21-J shock for ventricular tachycardia (VT) or VF Ն200 bpm and were followed up for 1 year. Of 420 patients who underwent 14-J vulnerability safety margin screening, 322 (76.7%) passed. Of these, 317 (98.4%) also passed 21-J confirmatory tests. Of 416 patients who underwent 14-J defibrillation safety margin screening, 343 (82.5%) passed, and 338 (98.5%) also passed 21-J confirmatory tests. Most clinical VT/VF episodes (32 of 37, or 86%) were terminated by the first shock, with no difference in first shock success. In all observed cases in which the first shock was unsuccessful, subsequent shocks terminated VT/VF without complication. Conclusions-Although spontaneous episodes of fast VT/VF were limited, there was no difference in the odds of first shock efficacy between groups. Screening with vulnerability safety margin or defibrillation safety margin may allow for inductionless or limited shock testing in most patients.

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Section: Discussionmentioning

confidence: 99%

Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators

et al. 2007

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“…Although shocks alone may depress myocardial contractility, 42 significant hypotension is more common after a single fibrillation-defibrillation episode than after 3 T-wave shocks that do not induce VF (8% vs 2%, P 5 .006). 43 In another study, prolonged hypotension did not occur in any of 394 patients during vulnerability safety margin testing, whereas it occurred in 2% of a subgroup of patients after 1 episode of induced VF. 29 Vulnerability testing reduces the risks associated with VF to the extent that it minimizes induction of VF.…”

Section: Risksmentioning

confidence: 91%

Should You Use DFT or ULV to Assess Defibrillation Efficacy?

Swerdlow

Birgersdotter‐Green

2011

Cardiac Electrophysiology Clinics

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“…Bayesian defibrillation testing is the most efficient method (11). Testing based on the upper limit of vulnerability permits the assessment of defibrillation efficacy without inducing VF in 80% to 90% of implants (12)(13)(14). An interleaved Bayesian combination of defibrillation and vulnerability testing is one method to maximize the information derived from implant testing.…”

Section: Alternative Perspectivementioning

confidence: 99%

Reappraisal of implant testing of implantable cardioverter defibrillators**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.

Swerdlow¹

2004

Journal of the American College of Cardiology

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Most patients may safely undergo inductionless or limited shock testing at ICD implantation

Cited by 6 publications

References 0 publications

Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators

Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators

Should You Use DFT or ULV to Assess Defibrillation Efficacy?

Reappraisal of implant testing of implantable cardioverter defibrillators**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.

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