1
|
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?"
Collapse
|
2
|
Bänsch D, Bonnemeier H, Brandt J, Bode F, Svendsen JH, Táborský M, Kuster S, Blomström-Lundqvist C, Felk A, Hauser T, Suling A, Wegscheider K. Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial. Eur Heart J 2015; 36:2500-7. [PMID: 26112885 PMCID: PMC4589656 DOI: 10.1093/eurheartj/ehv292] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/07/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS This trial was designed to test the hypothesis that shock efficacy during follow-up is not impaired in patients implanted without defibrillation (DF) testing during first implantable cardioverter-defibrillator (ICD) implantation. METHODS AND RESULTS Between February 2011 and July 2013, 1077 patients were randomly assigned (1 : 1) to first time ICD implantation with (n = 540) or without (n = 537) DF testing. The intra-operative DF testing was standardized across all participating centres, and all ICD shocks were programmed to 40 J irrespective of DF test results. The primary end point was the average first shock efficacy (FSE) for all true ventricular tachycardia and fibrillation (VT/VF) episodes during follow-up. The secondary end points included procedural data, serious adverse events, and mortality. During a median follow-up of 22.8 months, the model-based FSE was found to be non-inferior in patients with an ICD implanted without a DF test, with a difference in FSE of 3.0% in favour of the no DF test [confidence interval (CI) -3.0 to 9.0%, Pnon-inferiority <0.001 for the pre-defined non-inferiority margin of -10%). A total of 112 procedure-related serious adverse events occurred within 30 days in 94 patients (17.6%) tested compared with 89 events in 74 patients (13.9%) not tested (P = 0.095). CONCLUSION Defibrillation efficacy during follow-up is not inferior in patients with a 40 J ICD implanted without DF testing. Defibrillation testing during first time ICD implantation should no longer be recommended for routine left-sided ICD implantation.
Collapse
Affiliation(s)
- Dietmar Bänsch
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, Rostock 18057, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johan Brandt
- Arrhythmia Department, Skane University Hospital, Lund, Sweden
| | - Frank Bode
- Medical Clinic II Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jesper Hastrup Svendsen
- Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark Danish Arrhythmia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Miloš Táborský
- Department of Internal Medicine I Cardiology, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | - Stefan Kuster
- Department of Internal Medicine, Cardiology, DRK Hospital Mölln-Ratzeburg, Ratzeburg, Germany
| | | | | | | | - Anna Suling
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | |
Collapse
|
3
|
Bänsch D, Bonnemeier H, Brandt J, Bode F, Svendsen JH, Felk A, Hauser T, Wegscheider K. The NO Regular Defibrillation testing In Cardioverter Defibrillator Implantation (NORDIC ICD) trial: concept and design of a randomized, controlled trial of intra-operative defibrillation testing during de novo defibrillator implantation. Europace 2014; 17:142-7. [PMID: 25107947 DOI: 10.1093/europace/euu161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Although defibrillation (DF) testing is still considered a standard procedure during implantable cardioverter-defibrillator (ICD) insertion and has been an essential element of all trials that demonstrated the survival benefit of ICD therapy, there are no large randomized clinical trials demonstrating that DF testing improves clinical outcome and if the outcome would remain the same by omitting DF testing. METHODS AND RESULTS Between February 2011 and July 2013, we randomly assigned 1077 patients to ICD implantation with (n = 540) or without (n = 537) DF testing. The intra-operative DF testing was standardized across all participating centres. After inducing a fast ventricular tachycardia (VT) with a heart rate ≥240 b.p.m. or ventricular fibrillation (VF) with a low-energy T-wave shock, DF was attempted with an initial 15 J shock. If the shock reversed the VT or VF, DF testing was considered successful and terminated. If unsuccessful, two effective 24 J shocks were administered. If DF was unsuccessful, the system was reconfigured and another DF testing was performed. An ICD shock energy of 40 J had to be programmed in all patients for treatment of spontaneous VT/VF episodes. The primary endpoint was the average efficacy of the first ICD shock for all true VT/VF episodes in each patient during follow-up. The secondary endpoints included the frequency of system revisions, total fluoroscopy, implantation time, procedural serious adverse events, and all-cause, cardiac, and arrhythmic mortality during follow-up. Home Monitoring was used in all patients to continuously monitor the system integrity, device programming and performance. CONCLUSION The NO Regular Defibrillation testing In Cardioverter Defibrillator Implantation (NORDIC ICD) trial is one of two large prospective randomized trials assessing the effect of DF testing omission during ICD implantation. CLINICALTRIALSGOV IDENTIFIER NCT01282918.
Collapse
Affiliation(s)
- Dietmar Bänsch
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III Cardiology and Angiology, University Hospital Schleswig-Holstein, campus Kiel, 24105 Kiel, Germany
| | - Johan Brandt
- Arrhythmia Department, Skane University Hospital, S-221 85 Lund, Sweden
| | - Frank Bode
- Medical Clinic II Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, campus Lübeck, 23538 Lübeck, Germany
| | - Jesper Hastrup Svendsen
- Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, DK-2100 Copenhagen, Denmark Danish Arrhythmia Research Centre, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Angelika Felk
- Clinical Affairs & Reimbursement CENEMEA, Biotronik Berlin, 12359 Berlin, Germany
| | - Tino Hauser
- Clinical Affairs & Reimbursement CENEMEA, Biotronik Berlin, 12359 Berlin, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | | |
Collapse
|
4
|
|
5
|
Russo AM, Chung MK. Is Defibrillation Testing Necessary for Implantable Transvenous Defibrillators? Circ Arrhythm Electrophysiol 2014; 7:337-46. [DOI: 10.1161/circep.113.000371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea M. Russo
- From the Cooper Medical School of Rowan University, Camden, NJ (A.M.R.); and Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (M.K.C.)
| | - Mina K. Chung
- From the Cooper Medical School of Rowan University, Camden, NJ (A.M.R.); and Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (M.K.C.)
| |
Collapse
|
6
|
Kempa M, Budrejko S, Drelich L, Królak T, Raczak G, Kozłowski D. Implantation of additional subcutaneous array electrode reduces defibrillation threshold in ICD patients - preliminary results. Arch Med Sci 2013; 9:440-4. [PMID: 23847664 PMCID: PMC3701990 DOI: 10.5114/aoms.2013.35480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 10/25/2012] [Accepted: 11/30/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Among the recipients of implantable cardioverter-defibrillators (ICDs), there is a group of patients in whom the defibrillation threshold (DFT) is too high to enable a sufficient safety margin between the DFT and the maximal available output of the device. The aim of the study was to investigate the ability of an additionally implanted single-coil subcutaneous array electrode to reduce the DFT in such patients. MATERIAL AND METHODS Medtronic 6996SQ electrode was implanted in 15 patients selected from our follow-up group of 741 ICD patients: 10 of them had insufficient post-implant DFT safety margin, and 5 had ineffective first maximal energy shock as recorded by the device. In 6 cases the patients had CRT-D devices, in 5 cases - dual-chamber ICDs, and in 4 cases - single-chamber ICDs. In all patients but one the defibrillating electrode was single-coil. In one patient it was dual-coil. The underlying disease was coronary artery disease in 10 patients, dilated cardiomyopathy in 4 patients and hypertrophic cardiomyopathy in 1 patient. RESULTS The subcutaneous electrode was successfully implanted in all the patients qualified for the procedure. No technical issues or perioperative complications were observed. Mean DFT was reduced from 33.3 ±4.1 J before the procedure to 25.3 ±4.4 J after the implantation procedure (p < 0.01). CONCLUSIONS Our results show that the use of a single-coil subcutaneous electrode to reduce the DFT is a safe and effective procedure. Further studies are necessary to confirm these results.
Collapse
Affiliation(s)
- Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | | | | | | | | |
Collapse
|
7
|
Bastian D, Kracker S, Pauschinger M, Göhl K. ICD implantation without intraoperative testing does not increase the rate of system modifications and does not impair defibrillation efficacy tested in follow-up. Herzschrittmacherther Elektrophysiol 2013; 24:125-30. [PMID: 23744101 DOI: 10.1007/s00399-013-0267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
AIM The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions. METHODS In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks. RESULTS Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %. CONCLUSION Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.
Collapse
Affiliation(s)
- Dirk Bastian
- Division of Cardiology and Electrophysiology, Medizinische Klinik 8, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471, Nuremberg, Germany.
| | | | | | | |
Collapse
|
8
|
Steinberg C, Sarrazin JF, Philippon F, Bouchard MA, O'Hara G, Molin F, Nault I, Blier L, Champagne J. Detection of high incidence of Riata lead breaches by systematic postero-anterior and lateral chest X-ray in a large cohort. ACTA ACUST UNITED AC 2012; 15:402-8. [DOI: 10.1093/europace/eus339] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
9
|
Ra H, Shin S, Kim J, Lim H, Cho B, Roh M. The impact of dermatological toxicities of anti-cancer therapy on the dermatological quality of life of cancer patients. J Eur Acad Dermatol Venereol 2012; 27:e53-9. [DOI: 10.1111/j.1468-3083.2012.04466.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|