Testing and Programming of Implantable Defibrillator Functions at Implantation

Kroll, Mark W.; Tchou, Patrick

doi:10.1016/b978-1-4160-2536-8.50022-4

Cited by 15 publications

(11 citation statements)

References 245 publications

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“…36 Reasons for such ICD-unresponsive SCD may be patient or device related, including refractory electrical storm, asystole, pulseless electrical activity or technical defects of the implanted device and leads or potentially elevated defibrillation thresholds (DFTs). 37 While there are several reports on changes of DFT by antiarrhythmic drugs in the literature (mostly historical studies and case reports from the 1980s and 1990s), there are few recent data regarding pacing threshold.…”

Section: Potential Influences On Pacing and Defibrillation Thresholdsmentioning

confidence: 99%

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Abboud

Ehrlich

2016

Arrhythmia &Amp; Electrophysiology Review

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Implantable cardioverter defibrillators (ICDs) have been used for over 30 years to prevent sudden cardiac death (SCD). The first indications for ICD placement were secondary prevention; later trials demonstrated a primary prevention benefit of ICD therapy in patients at risk of SCD. ICD therapy prolongs life in both patient populations. 1 However, the efficacy of an ICD depends on its ability to correctly detect ventricular arrhythmia and deliver antitachycardia pacing or shocks. In cases of inadequate arrhythmia classification by the device, atrial fibrillation (AF) with rapid conduction to the ventricles can lead to inappropriate shocks. The ability of an ICD to correctly detect this arrhythmia is essential to avoid shock delivery. Furthermore, technical problems such as lead fractures, oversensing of myopotentials or external noise can lead to shock application. ICD shocks can be painful if experienced in the awake state and may reduce quality of life in affected patients.2 Shocks, whether appropriate or not, tend to occur frequently after the implantation of an ICD and avoiding shocks is a reasonable therapeutic target. 3 Current evidence suggests that ICD shocks increase the risk of mortality.4 It remains a matter of debate if this finding depends on the context of a specific cardiac substrate or the shock per se.5 Of less controversy is the fact that patients who receive ICD shocks experience reduced quality of life. This has been a consistent finding in published studies that was already evident from data in the first available trials, such as the Antiarrhythmics Versus ICDs (AVID) trial. The occurrence of ICD shocks was associated with reduced physical functioning and decreased mental wellbeing. Another study reported that patients who experienced an ICD shock did not adapt well to living with an ICD and were generally more anxious than ICD recipients who received no shock.6 Accordingly, shock reduction by medical, interventional or technical means is a desirable goal. General MeasuresMost patients receiving ICDs for primary prevention of SCD are affected by heart failure with reduced left ventricular ejection fraction (LVEF <35 %). Should these patients meet the criteria for cardiac resynchronisation therapy (CRT), implantation is indicated to achieve mortality and morbidity benefits. 7 In addition, CRT responders exhibit fewer ventricular tachycardia/ventricular fibrillation (VT/VF) episodes after implantation than patients not receiving CRT.8 In general, care should be taken to keep these patients on optimal medical therapy including high-dose b-blockers, as these drugs lead to a reduction in rates of SCD and overall mortality in patients with ischaemic and non-ischaemic cardiomyopathy. If such treated patients develop arrhythmias despite b-blocker treatment, an additional anti-arrhythmic treatment will be necessary. In clinical practice, an adjunctive antiarrhythmic is administered to more than half of patients who have an ICD. Serum Potassium LevelsBesides pharmacological interventions, simple meth...

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Section: Potential Influences On Pacing and Defibrillation Thresholdsmentioning

confidence: 99%

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Abboud

Ehrlich

2016

Arrhythmia &Amp; Electrophysiology Review

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“…1 These unsettled issues include the optimal defibrillation lead configuration, need for waveform optimization at implantation, hemodynamic sequelae of ICD testing, and the need for yearly ICD testing to confirm response to ventricular fibrillation among others. Probably no aspect of ICD therapy is more unsettled than the effects of antiarrhythmics and other drugs on the DFT.…”

Section: Article P 104mentioning

confidence: 99%

“…Despite 20 years of clinical use, however, there exist many unresolved issues in ICD therapy. 1 Even the most fundamental aspect of ICD implantation, defibrillation threshold (DFT) testing, is not standardized. Determining a DFT is fundamentally different from determining a pacing threshold.…”

mentioning

confidence: 99%

“…Determining a DFT is fundamentally different from determining a pacing threshold. 1,2 The latter is essentially a fixed value at a given combination of pulse width and voltage. Clinically, there is a sharp demarcation of pacing voltages that capture and those that do not.…”

mentioning

confidence: 99%

“…The dose-response curve for defibrillation is described as sigmoidal in shape with a higher likelihood of success at higher energies. 1,2 The possibility of an "outlier" event, defibrillation at low energy, or failure at higher energy remains present. Defining a true defibrillation threshold, ie, that energy above which defibrillation will always succeed and below which it will always fail, is not the goal of defibrillation testing in the clinical setting.…”

mentioning

confidence: 99%

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The sections in this article are The Heart Rhythm The Development of Pacemaker Therapy Operating Modes and Pacemaker Codes Electrodes Battery Basic Functions of the Dual‐Chamber Pacemaker Technical Solution Telemetry Rate‐Adaptive Pacemakers Conclusion

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Testing and Programming of Implantable Defibrillator Functions at Implantation

Cited by 15 publications

References 245 publications

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Follow-Up Defibrillator Testing for Antiarrhythmic Drugs

Pacemakers

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