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Chaudry HA, Maskoun W. An intuitive method to reduce the defibrillation threshold: a case report. Eur Heart J Case Rep 2023; 7:ytad577. [PMID: 38046647 PMCID: PMC10691872 DOI: 10.1093/ehjcr/ytad577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Background Defibrillation threshold (DFT) testing is done to assess whether proper sensing of ventricular fibrillation and adequate safety margin for defibrillation are present in an implantable cardioverter defibrillator (ICD). This case report presents an intuitive method for lowering the DFT. It may be used on a larger scale in other patients with high DFTs when other methods for lowering the DFT (changing medications, adjusting the device, and adding coils) are not feasible or preferable to use. Case summary A 64-year-old male presented to the emergency room with failed appropriate shocks from his ICD. Device interrogation revealed that he failed his first maximum output shock before subsequent shock at the same polarity and output succeeded, suggesting a high DFT. Therefore, the DFT needs to be lowered in our patient. After considering the potential efficacy and risk of a number of traditional options, we used an intuitive method whereby the right ventricular (RV) coils of two separate leads were combined via a y-adapter. This method successfully lowered the patient's DFT, and he received successful shocks from his ICD over the next 9 months before reaching end-stage heart failure. He received a transplant, and the device and transvenous leads, except for the superior vena cava coil, were successfully removed. Discussion Combining two RV coils from different locations may lower the DFT. This method may be considered in the larger population in cases where using traditional methods are not safe or possible for certain patients. This method may work by lowering shock impedance and increasing the shock tissue surface area.
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Affiliation(s)
- Hayyan Asim Chaudry
- Division of Electrophysiology, Department of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Waddah Maskoun
- Division of Electrophysiology, Department of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
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2
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Left axillary active can positioning markedly reduces defibrillation threshold of a transvenous defibrillator failing to defibrillate at maximum output. HeartRhythm Case Rep 2018; 5:36-39. [PMID: 30693203 PMCID: PMC6342727 DOI: 10.1016/j.hrcr.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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3
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Garg J, Chaudhary R, Shah N, Palaniswamy C, Bozorgnia B, Nazir T, Natale A, Kutyifa V. Right ventricular apical versus non-apical implantable cardioverter defibrillator lead: A systematic review and meta-analysis. J Electrocardiol 2017; 50:591-597. [DOI: 10.1016/j.jelectrocard.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 10/19/2022]
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Amit G, Wang J, Connolly SJ, Glikson M, Hohnloser S, Wright DJ, Brachmann J, Defaye P, Neuzner J, Mabo P, Vanerven L, Vinolas X, O'Hara G, Kautzner J, Appl U, Gadler F, Stein K, Konstantino Y, Healey JS. Apical versus Non-Apical Lead: Is ICD Lead Position Important for Successful Defibrillation? J Cardiovasc Electrophysiol 2016; 27:581-6. [PMID: 26888558 DOI: 10.1111/jce.12952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/25/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. METHODS AND RESULTS The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. CONCLUSION We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.
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Affiliation(s)
- Guy Amit
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jia Wang
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | | | | | | | | - Gilles O'Hara
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ursula Appl
- Boston Scientific, Minneapolis, Minnesota, USA.,Boston Scientific, Brussels, Belgium
| | | | - Kenneth Stein
- Boston Scientific, Minneapolis, Minnesota, USA.,Boston Scientific, Brussels, Belgium
| | | | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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SHIH MICHAELJ, KAKODKAR SIDDHARTHA, KAID YOUSEF, HASSEL JONATHANL, YARLAGADDA SANTI, FOGG LOUISF, MADIAS CHRISTOPHER, KRISHNAN KOUSIK, TROHMAN RICHARDG. Reassessing Risk Factors for High Defibrillation Threshold: The EF-SAGA Risk Score and Implications for Device Testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:483-9. [DOI: 10.1111/pace.12838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 01/27/2016] [Accepted: 02/21/2016] [Indexed: 11/27/2022]
Affiliation(s)
- MICHAEL J. SHIH
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - SIDDHARTH A. KAKODKAR
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - YOUSEF KAID
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - JONATHAN L. HASSEL
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - SANTI YARLAGADDA
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - LOUIS F. FOGG
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - CHRISTOPHER MADIAS
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - KOUSIK KRISHNAN
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
| | - RICHARD G. TROHMAN
- Department of Medicine, Division of Cardiology, Electrophysiology, Arrhythmia and Pacemaker Service; Rush University Medical Center; Chicago Illinois
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Bonnes JL, Westra SW, Bouwels LHR, DE Boer MJ, Brouwer MA, Smeets JLRM. Risk Factors for Inadequate Defibrillation Safety Margins Vary With the Underlying Cardiac Disease: Implications for Selective Testing Strategies. J Cardiovasc Electrophysiol 2016; 27:587-93. [PMID: 26824826 DOI: 10.1111/jce.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In view of the shift from routine toward no or selective defibrillation testing, optimization of the current risk stratification for inadequate defibrillation safety margins (DSMs) could improve individualized testing decisions. Given the pathophysiological differences in myocardial substrate between ischemic and nonischemic heart disease (IHD/non-IHD) and the accompanying differences in clinical characteristics, we studied inadequate DSMs and their predictors in relation to the underlying etiology. METHODS AND RESULTS Cohort of routine defibrillation tests (n = 785) after first implantable cardioverter defibrillator (ICD)-implantations at the Radboud UMC (2005-2014). A defibrillation threshold >25 J was regarded as an inadequate DSM. In total, 4.3% of patients had an inadequate DSM; in IHD 2.5% versus 7.3% in non-IHD (P = 0.002). We identified a group of non-IHD patients at high risk (13-42% inadequate DSM); the remainder of the cohort (>70%) had a risk of only 2% (C-statistic entire cohort 0.74; C-statistic non-IHD 0.82). This was based upon two identified interaction terms: (1) non-IHD and age (aOR 0.94 [95% CI 0.91-0.97]); (2) non-IHD and the indexed left ventricular (LV) internal diastolic diameter (aOR 3.50 [95% CI 2.10-5.82]). CONCLUSION The present study on risk stratification for an inadequate DSM not only confirms the importance of making a distinction between IHD and non-IHD, but also shows that risk factors in an entire cohort (LV dilatation, age) may only apply to a subgroup (non-IHD). Appreciation of this concept could favorably affect current risk stratification. If confirmed, our approach may be used to optimize individualized testing decisions in an upcoming era of non-routine testing.
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Affiliation(s)
- Judith L Bonnes
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leon H R Bouwels
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Menko Jan DE Boer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joep L R M Smeets
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Defibrillation Threshold Testing: Who Doesn't Get It? Card Electrophysiol Clin 2016; 4:135-41. [PMID: 26939810 DOI: 10.1016/j.ccep.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Defibrillation testing has been routinely performed as part of the implantable cardioverter-defibrillator (ICD) implantation procedure, and is currently supported by practice guidelines; however, more recently, this practice has been called into question. Such testing is safe, and serious complications are rare. With modern ICD systems, physicians will rarely encounter a patient in whom defibrillation will fail. This article reviews the literature regarding the utility, necessity, complications, and cost of routine operative and follow-up defibrillation testing, and, it is hoped, clarifies the issue of "Who doesn't get it?"
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8
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Kanda T, Masuda M, Sunaga A, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, Shiraki T, Sera F, Uematsu M. Fabry cardiomyopathy presenting with a high defibrillation threshold: A short case report. J Arrhythm 2015; 31:170-1. [DOI: 10.1016/j.joa.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022] Open
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Traumatic Tension Pneumothorax as a Cause of ICD Failure: A Case Report and Review of the Literature. Case Rep Cardiol 2014; 2014:261705. [PMID: 25400953 PMCID: PMC4220567 DOI: 10.1155/2014/261705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Tension pneumothorax can infrequently cause ventricular arrhythmias and increase the threshold of defibrillation. It should be suspected whenever there is difficulty in defibrillation for a ventricular arrhythmia. Purpose. To report a case of traumatic tension pneumothorax leading to ventricular tachycardia and causing defibrillator failure. Case. A 65-year-old African-American female was brought in to our emergency department complaining of dyspnea after being forced down by cops. She had history of mitral valve replacement for severe mitral regurgitation and biventricular implantable cardioverter defibrillator inserted for nonischemic cardiomyopathy. Shortly after arrival, she developed sustained ventricular tachycardia, causing repetitive unsuccessful ICD shocks. She was intubated and ventricular tachycardia resolved with amiodarone. Chest radiograph revealed large left sided tension pneumothorax which was promptly drained. The patient was treated for congestive heart failure; she was extubated on the third day of admission, and the chest tube was removed. Conclusion. Prompt recognition of tension pneumothorax is essential, by maintaining a high index of suspicion in patients with an increased defibrillation threshold causing ineffective defibrillations.
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Mizukami K, Yokoshiki H, Mitsuyama H, Watanabe M, Tenma T, Matsui Y, Tsutsui H. Predictors of high defibrillation threshold in patients with implantable cardioverter-defibillator using a transvenous dual-coil lead. Circ J 2014; 79:77-84. [PMID: 25391259 DOI: 10.1253/circj.cj-14-0860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Defibrillation testing (DT) is considered a standard procedure during implantable cardioverter-defibrillator (ICD) implantation. However, little is known about the factors that are significantly related to patients with high defibrillation threshold (DFT) using the present triad system. METHODS AND RESULTS We examined 286 consecutive patients who underwent ICD implantation with a transvenous dual-coil lead and DT from December 2000 to December 2011. We defined patients who required 25 J or more by the implanted device as the high DFT group, and those who required less than 25 J as the normal DFT group. For each patient, assessment parameters included underlying disease, comorbidities, NYHA functional class, drugs, and echocardiographic measures. The high DFT group consisted of 12 patients (4.2%). Multivariate analysis identified 3 independent predictors for high DFT: atrial fibrillation (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.24-22.33, P=0.023), hypertension (OR 4.01, 95% CI 1.08-15.96, P=0.039), thickness of interventricular septum (IVS) >12 mm (OR 4.82, 95% CI 1.17-20.31, P=0.030). CONCLUSIONS Atrial fibrillation, hypertension and IVS hypertrophy were significantly associated with high DFT. Identification of such patients could help to lower the risk of complications with DT.
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Affiliation(s)
- Kazuya Mizukami
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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11
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Hsu JC, Marcus GM, Al-Khatib SM, Wang Y, Curtis JP, Sood N, Parker MW, Kluger J, Lampert R, Russo AM. Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol 2014; 64:256-64. [PMID: 25034061 DOI: 10.1016/j.jacc.2014.01.085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Defibrillation testing is often performed to establish effective arrhythmia termination, but predictors and consequences of an inadequate defibrillation safety margin (DSM) remain largely unknown. OBJECTIVES The aims of this study were to develop a simple risk score predictive of an inadequate DSM at implantable cardioverter-defibrillator (ICD) implantation and to examine the association of an inadequate DSM with adverse events. METHODS A total of 132,477 ICD Registry implantations between 2010 and 2012 were analyzed. Using logistic regression models, factors most predictive of an inadequate DSM (defined as the lowest successful energy tested <10 J from maximal device output) were identified, and the association of an inadequate DSM with adverse events was evaluated. RESULTS Inadequate DSMs occurred in 12,397 patients (9.4%). A simple risk score composed of 8 easily identifiable variables characterized patients at high and low risk for an inadequate DSM, including (with assigned points) age <70 years (1 point); male sex (1 point); race: black (4 points), Hispanic (2 points), or other (1 point); New York Heart Association functional class III (1 point) or IV (3 points); no ischemic heart disease (2 points); renal dialysis (3 points); secondary prevention indication (1 point); and ICD type: single-chamber (2 points) or biventricular (1 point) device. An inadequate DSM was associated with greater odds of complications (odds ratio: 1.22; 95% confidence interval: 1.09 to 1.37; p = 0.0006), hospital stay >3 days (odds ratio: 1.24; 95% confidence interval: 1.19 to 1.30; p < 0.0001), and in-hospital mortality (odds ratio: 1.96; 95% confidence interval: 1.63 to 2.36; p < 0.0001). CONCLUSIONS A simple risk score identified ICD recipients at risk for an inadequate DSM. An inadequate DSM was associated with an increased risk for in-hospital adverse events.
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Affiliation(s)
- Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, University of California, San Diego, San Diego, California.
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nitesh Sood
- Cardiac Arrhythmia Services, Southcoast Health System, Fall River, Massachusetts
| | - Matthew W Parker
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Jeffrey Kluger
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
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12
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Inbar S, Seethala S. A Novel Solution for the High Defibrillation Threshold in Patients with a DF-4 Lead: Adding a High Voltage Adaptor/Splitter. Indian Pacing Electrophysiol J 2014; 14:152-6. [PMID: 24920870 PMCID: PMC4032782 DOI: 10.1016/s0972-6292(16)30756-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A high defibrillation threshold occurs in approximately 6% of implants. The defibrillation threshold can be improved by addition of a defibrillation lead. However, the DF-4 high energy ICD header precludes the addition of a defibrillation lead. Here we report on use of a new high voltage adaptor/splitter that enables the addition of an extra defibrillation lead.
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Affiliation(s)
- Shmuel Inbar
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Srikanth Seethala
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
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13
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Hayes K, Deshmukh A, Pant S, Tobler G, Paydak H. Concept of defibrillation vector in the management of high defibrillation threshold. World J Cardiol 2013; 5:106-108. [PMID: 23675557 PMCID: PMC3653010 DOI: 10.4330/wjc.v5.i4.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/24/2012] [Accepted: 03/23/2013] [Indexed: 02/06/2023] Open
Abstract
We present a case where defibrillation threshold was dangerously elevated to the point that the patient had no safety margin, and his implantable cardioverter-defibrillator generator was discovered to have migrated. Generator migration reduces the distance between the can and the coil, effectively creating a smaller bipolar current and sparing the left ventricle from the current needed for defibrillation. This case underscores the importance of securing the generator in place, as this patient would have been spared multiple shocks and an invasive medical procedure had his generator been better secured.
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14
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ZAKI ALY, ZAIDI AMIR, NEWMAN WILLIAMG, GARRATT CLIFFORDJ. Advantages of a Subcutaneous Implantable Cardioverter-Defibrillator in LAMP2
Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2013; 24:1051-3. [DOI: 10.1111/jce.12142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/03/2013] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- ALY ZAKI
- Manchester Heart Centre/Institute of Cardiovascular Medicine
- Centre for Genetic Medicine, Institute of Human Development; University of Manchester, Manchester Academic Health Science Centre; Manchester UK
| | - AMIR ZAIDI
- Manchester Heart Centre/Institute of Cardiovascular Medicine
| | - WILLIAM G. NEWMAN
- Centre for Genetic Medicine, Institute of Human Development; University of Manchester, Manchester Academic Health Science Centre; Manchester UK
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GAN TIANYI, CAO XIAOZHI, YU ZHANG, TANG BAOPENG, LI JINXIN, XU GUOJUN, ZHOU XIANHUI, ZHANG YANYI, LI YAODONG, ZHANG JIANGHUA. Intraoperative defibrillation threshold testing and postoperative long-term efficacy of cardioverter-defibrillator implantation. Exp Ther Med 2013; 5:323-327. [PMID: 23251292 PMCID: PMC3524161 DOI: 10.3892/etm.2012.797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/18/2012] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the defibrillation threshold (DFT) of implantable cardioverter-defibrillators (ICDs) and outcomes of treatment. Sixty-four patients received cardioverter-defibrillator implantation. During implantation, the DFT was determined by the defibrillation safety margin (DSM). All patients were followed up for 12–48 months after the implantation. The overall DFT was 14.27±2.56 J and the DSM was 18.40±1.89 J. Malignant ventricular arrhythmias occurred in 42 patients following cardioverter-defibrillator implantation including 500 episodes of non-sustained ventricular tachycardia (VT) and 289 episodes of persistent VT. VT was treated using antitachycardia pacing (ATP); 265 episodes were treated successfully by a single ATP treatment (91.69%) and 12 episodes were treated successfully by two ATP treatments (4.15%). Twelve episodes were converted by low-energy electrical cardioversion (4.15%). A total of 175 ventricular fibrillation (VF) episodes were identified, of which 18 episodes automatically terminated prior to treatment. In total, 146 episodes were converted by a single cardioversion with a defibrillation energy of 13.21±2.58 J and 11 episodes were converted by two cardioversions with a defibrillation energy of 16.19±2.48 J. It is safe and feasible to determine the DFT by DSM measurement during cardioverterdefibrillator implantation.
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16
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Singh HR, Batra AS, Balaji S. Cardiac pacing and defibrillation in children and young adults. Indian Pacing Electrophysiol J 2013; 13:4-13. [PMID: 23329870 PMCID: PMC3539397 DOI: 10.1016/s0972-6292(16)30584-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The population of children and young adults requiring a cardiac pacing device has been consistently increasing. The current generation of devices are small with a longer battery life, programming capabilities that can cater to the demands of the young patients and ability to treat brady and tachyarrhythmias as well as heart failure. This has increased the scope and clinical indications of using these devices. As patients with congenital heart disease (CHD) comprise majority of these patients requiring devices, the knowledge of indications, pacing leads and devices, anatomical variations and the technical skills required are different than that required in the adult population. In this review we attempt to discuss these specific points in detail to improve the understanding of cardiac pacing in children and young adults.
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Affiliation(s)
- Harinder R Singh
- The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan
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KAKODKAR SIDDHARTHA, PARIKH MILINDG, MADIAS CHRISTOPHER, TROHMAN RICHARDG, KRISHNAN KOUSIK. Intercostal Muscle Twitching from Right Ventricular Apical Pacing. Pacing Clin Electrophysiol 2012; 35:e197-8. [DOI: 10.1111/j.1540-8159.2011.03184.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation. J Interv Card Electrophysiol 2012; 34:93-100. [DOI: 10.1007/s10840-011-9648-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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SMITS KAREL, VIRAG NATHALIE. Impact of Defibrillation Test Protocol and Test Repetition on the Probability of Meeting Implant Criteria. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1515-26. [DOI: 10.1111/j.1540-8159.2011.03166.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Strauss M, Kleemann T, Weisse U, Sack FU, Zahn R. Additional coronary sinus defibrillation lead with a right pectoral ICD and high DFT : a case report. Herzschrittmacherther Elektrophysiol 2011; 22:121-3. [PMID: 21479600 DOI: 10.1007/s00399-011-0134-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
We report the case of a 63-year-old man with ischemic cardiomyopathy having an implantable cardioverter defibrillator (ICD) implanted for repeated ventricular tachycardia (VT). After several revisions of the ICD lead, a thrombosis of the left venous system was diagnosed. A right pectoral ICD device was implanted, and a sufficient defibrillation threshold (DFT) could not be achieved during the operation. Thus, a further defibrillation lead was implanted into the coronary sinus, which successfully terminated ventricular fibrillation.
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Affiliation(s)
- M Strauss
- Arrhythmia Institute at the Heart Center Ludwigshafen, Cardiology, Deutschland.
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21
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Kroll MW. To the Editor: End of the apex era? Heart Rhythm 2011; 8:e9-10. [DOI: 10.1016/j.hrthm.2011.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Indexed: 10/18/2022]
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22
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Safe and effective use of conscious sedation for defibrillation threshold testing during ICD implantation. J Saudi Heart Assoc 2010; 22:209-13. [PMID: 23960622 DOI: 10.1016/j.jsha.2010.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 07/03/2010] [Accepted: 07/13/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Over a period of years general anesthesia has been a standard anesthetic technique for defibrillation threshold (DFT) testing at the time of implant. DFT testing without general anesthesia cover has gained limited acceptance. Use of local anesthesia combined with deep sedation for DFT testing might facilitate and simplify these procedures by reducing the procedural time, staff time, avoiding inefficient service in organizing anesthetic cover; thereby improving patient compliance. OBJECTIVE The objective of this study was to evaluate feasibility, safety and efficacy of conscious sedation for DFT testing during Implantable cardioverter defibrillators (ICD) implantation. METHOD Data of 87 non-selected patients who achieved adequate sedation with titrated doses of midazolam and pethidine were analyzed retrospectively. These medications were administered by a circulating nurse under the supervision of the implanting physicians. All hemodynamic measures, treatment and complications were monitored and recorded throughout the procedure. RESULTS A retrospective analysis of data from 87 patients who underwent ICD implantation and DFT testing under conscious sedation at our center was reported. The mean dose of midazolam and pethidine administered was 4.9 ± 1.8 and 47.7 ± 20 mg, respectively. During the period of conscious sedation, no patient depicted episode of sustained apnea. No major complication or mortality was reported. CONCLUSION Use of conscious sedation as an alternative to the use of general anesthesia for DFT testing during ICD implantation is found to be feasible, safe and effective, with an added advantage of reduced procedural time and improved patient compliance.
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Verma A, Kaplan AJ, Sarak B, Oosthuizen R, Beardsall M, Higgenbottam J, Wulffhart Z, Khaykin Y. Incidence of very high defibrillation thresholds (DFT) and efficacy of subcutaneous (SQ) array insertion during implantable cardioverter defibrillator (ICD) implantation. J Interv Card Electrophysiol 2010; 29:127-33. [PMID: 20865309 DOI: 10.1007/s10840-010-9511-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 08/04/2010] [Indexed: 11/24/2022]
Affiliation(s)
- Atul Verma
- Southlake Heart Rhythm Program, Southlake Regional Health Centre, 105-712 Davis Drive, Newmarket, ON, Canada.
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Kroll MW, Schwab JO. Achieving low defibrillation thresholds at implant: pharmacological influences, RV coil polarity and position, SVC coil usage and positioning, pulse width settings, and the azygous vein. Fundam Clin Pharmacol 2010; 24:561-73. [DOI: 10.1111/j.1472-8206.2010.00848.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Estimating the Parameter Distributions of Defibrillation Shock Efficacy Curves in a Large Population. Ann Biomed Eng 2010; 38:1314-25. [DOI: 10.1007/s10439-009-9890-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 12/24/2009] [Indexed: 10/20/2022]
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Hadano Y, Ogawa H, Wakeyama T, Takaki A, Iwami T, Kimura M, Miyazaki Y, Okada H, Shimizu A, Matsuzaki M. Defibrillation efficacy of a subcutaneous array lead: A case report. J Cardiol Cases 2009; 1:e21-e24. [PMID: 30615746 DOI: 10.1016/j.jccase.2009.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 05/31/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022] Open
Abstract
We report a case of Brugada syndrome with a high defibrillation threshold (DFT) in whom a subcutaneous array lead was used to lower the DFT in combination with a transvenous right ventricular defibrillation lead. The patient had previously received pacemaker implantation due to sick sinus syndrome. An implantable cardioverter defibrillator (ICD) with a transvenous right ventricular defibrillation lead alone required a high DFT. A subcutaneous array lead improved defibrillation efficacy in combination with a right ventricular lead. These data suggest that a subcutaneous array lead facilitates implantation of an effective ICD lead system in patients requiring a high DFT.
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Affiliation(s)
- Yasuyuki Hadano
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Hiroshi Ogawa
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Takatoshi Wakeyama
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Akira Takaki
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Takahiro Iwami
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Masayasu Kimura
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Haruhiko Okada
- Division of Cardiac Surgery, Tokuyama Central Hospital, Shunan, Japan
| | - Akihiko Shimizu
- Faculty of Health and Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masunori Matsuzaki
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Dhoble A, Khasnis A, Olomu A, Thakur R. Cardiac amyloidosis treated with an implantable cardioverter defibrillator and subcutaneous array lead system: report of a case and literature review. Clin Cardiol 2009; 32:E63-5. [PMID: 19455567 PMCID: PMC6653454 DOI: 10.1002/clc.20389] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Accepted: 12/09/2007] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preventing ventricular arrhythmias in patients with cardiac amyloidosis is challenging since the amyloid protein deposition in the myocardium may interfere with the normal cardiac electric excitation. Most of these patients succumb to either progressive congestive heart failure, or sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) offers a near sure means of preventing SCD. HYPOTHESIS Myocardial infiltration with amyloid results in elevated defibrillation threshold (DFT). Intra-operative strategies may fail to lower DFT during implantation. METHODS We present a case of a 64-year-old female who had cardiac amyloidosis, and was successfully treated with an ICD and a subcutaneous array lead system. CONCLUSION A subcutaneous array lead system is useful in reducing the DFT, and can terminate ventricular tachycardia or fibrillation by allowing more energy delivery and efficient defibrillation.
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Affiliation(s)
- Abhijeet Dhoble
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | - Atul Khasnis
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | - Adesuwa Olomu
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | - Ranjan Thakur
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
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Ching CK, Elayi CS, Di Biase L, Barrett CD, Martin DO, Saliba WI, Wazni O, Kanj M, Burkhardt DJ, Schweikert RA, Wilkoff BL. Transiliac ICD implantation: Defibrillation vector flexibility produces consistent success. Heart Rhythm 2009; 6:978-83. [DOI: 10.1016/j.hrthm.2009.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 03/18/2009] [Indexed: 11/25/2022]
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Juchem G, Lang M, Golczyk K, Ulbrich M, Reichart B, Lamm P. Successful use of transvenous coil electrodes as single element subcutaneous array leads. Europace 2009; 11:391-4. [DOI: 10.1093/europace/eun382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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SIMON RONDB, STURDIVANT JLACY, LEMAN ROBERTB, WHARTON JMARCUS, GOLD MICHAELR. The Effect of Dofetilide on Ventricular Defibrillation Thresholds. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:24-8. [DOI: 10.1111/j.1540-8159.2009.02172.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosenheck S, Sharon Z, Weiss A. Long-Term Follow-Up of Patients with Relatively High Effective Defibrillation Threshold during Cardioverter Defibrillator Implantation with Endocardial Leads. Cardiology 2009; 112:107-13. [DOI: 10.1159/000141463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 04/10/2008] [Indexed: 11/19/2022]
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Abstract
Implantable cardioverter-defibrillators (ICDs) improve survival in patients who have left ventricular dysfunction; however, they are associated with numerous problems at implant and during follow-up. The diagnosis and management of these problems is usually straightforward, but more difficult problems may include the management of patients who have elevated energy requirements to terminate ventricular fibrillation or of those who have postoperative device infections. Long-term issues in ICD patients include the occurrence of inappropriate or frequent appropriate shocks. ICD generators and leads are more prone to failures than are pacing systems alone; management of patients potentially dependent on "recalled" devices to deliver life-saving therapy is a particularly complex issue. The purpose of this article is to review the diagnosis and management of these more troublesome ICD problems.
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Affiliation(s)
- Marcin Kowalski
- Department of Cardiac Electrophysiology Service, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0053, USA
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Sarkozy A, Brugada P, Mont L, Brugada J. Optimizing the clinical use of implantable defibrillators in patients with Brugada syndrome. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum070] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Swerdlow CD, Russo AM, Degroot PJ. The dilemma of ICD implant testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:675-700. [PMID: 17461879 DOI: 10.1111/j.1540-8159.2007.00730.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self-evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high-output ICDs, the probability of passing a 10 J safety margin is approximately 95%, the probability that a maximum output shock will defibrillate is approximately 99%, and the incidence of system revision based on testing is < or = 5%. Bayes' Theorem predicts that implant testing identifies < or = 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first-shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1-0.2%. Overall, VF should be induced to assess sensing in approximately 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20-40% of recipients who can be identified as having a higher-than-usual probability of an inadequate defibrillation safety margin based on patient-specific factors. However, implant testing is too risky in approximately 5% of recipients and may not be worth the risks in 10-30%. In 25-50% of ICD recipients, testing cannot be identified as either critical or contraindicated.
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Affiliation(s)
- Charles D Swerdlow
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
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Current World Literature. Curr Opin Cardiol 2007; 22:49-53. [PMID: 17143045 DOI: 10.1097/hco.0b013e3280126b20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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