The top 10 reasons to avoid defibrillation threshold testing during ICD implantation

Viskin, Sami; Rosso, Raphaël

doi:10.1016/j.hrthm.2008.01.006

Cited by 60 publications

(45 citation statements)

References 19 publications

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“…18) Stavrakis, et al, on the basis of a meta-analysis of studies involving patients followed up for a median of 24 months, also concluded that DFT testing at the time of ICD implantation does not reduce total mortality or ventricular arrhythmias. Viskin, et al 19) noted that by 2008 they had avoided DFT testing for quite a long time, citing a difference between inducible VF and spontaneous VF as 1 of 10 reasons for their decision. In our study, 5 (6.8%) and 4 (5.1%) ventricular tachyarrhythmic events and appropriate shocks were recorded in the DFT group and non-DFT group, respectively, with no significant difference between them.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…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

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“…Major complications or deaths associated with defibrillation testing are rare but have been reported. 3,4 …”

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confidence: 99%

Automated Vulnerability Testing Identifies Patients With Inadequate Defibrillation Safety Margin

Birgersdotter‐Green

Ruetz

Anand

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Implantable cardioverter-defibrillator system efficacy is tested at implant by induction of ventricular fibrillation (VF). Defibrillation safety margin can be assessed without VF induction using upper limit of vulnerability methods, but these methods have required manual determination of T-wave timing. Methods and Results-To test the feasibility of an inductionless system of implant testing, a multicenter prospective study of an automated vulnerability safety margin system was conducted, which measured T-wave timing using an intracardiac electrogram during a ventricular pacing train. The system delivered up to 4 T-wave shocks of 18 J. Lack of VF induction by all 4 shocks was considered evidence of defibrillation adequacy. Patients subsequently underwent conventional defibrillation testing to meet a standard implant criterion. The 95% lower CI for defibrillation success at 25 J for noninduced patients was found using Bayesian statistics. Sixty patients were enrolled at 6 centers. Vulnerability testing and defibrillation success results were obtained from 54 patients. Vulnerability testing induced VF in 10 (19%) patients, of whom 2 required system revision. All patients not induced by vulnerability testing were successfully defibrillated twice at ≤25 J. The Bayesian credible interval was 97% to 100% for the population success rate of defibrillation at 25 J for automated vulnerability safety margin noninduced patients. Conclusions-An automated system identified all patients who failed conventional safety margin testing, while inducing only 19% of patients. Although limited by sample size, this study suggests the feasibility of automated implant testing that substantially reduces the need for VF induction in patients receiving implantable cardioverter-defibrillators. (Circ Arrhythm Electrophysiol. 2012;5:1073-1080.)

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The top 10 reasons to avoid defibrillation threshold testing during ICD implantation

Cited by 60 publications

References 19 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

Automated Vulnerability Testing Identifies Patients With Inadequate Defibrillation Safety Margin

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