1
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Milman A, Nof E, Rav Acha M, Beinart R, Kutyifa V, Merkely B, Regev E, Biffi M, Cha YM, Ovdat T, Klempfner R, Glikson M. Outcome and safety of intraoperative defibrillation testing during device replacement: the Simpler trial. Europace 2023; 25:956-960. [PMID: 36636968 PMCID: PMC10062357 DOI: 10.1093/europace/euac282] [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: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Intraoperative defibrillation testing (DT) during implant or replacement of implantable cardioverter-defibrillators (ICDs) has been a matter of debate for many years. This debate was put to rest by the Simple and Nordic ICD trials, and the practice of testing during new implantations has essentially been almost abandoned. Old registries demonstrated an increased incidence of significant findings in DT during replacements. The aim of the present study was to evaluate frequency of significant findings and safety of DT in subjects undergoing device replacement. METHODS AND RESULTS A prospective observational multi-centre study included consecutive patients undergoing ICD generator replacement. The primary outcome was a failure to terminate induced ventricular fibrillation (VF) with a single shock 10 J below the maximal capacity of the device. Secondary outcomes included complications of DT. Patients were followed-up at 1- and 6-months post-procedure. A total of 92 patients were eligible, and consented to the study, of which 84 underwent DT during battery replacement. The median age was 68 years and 79.8% were males. Induction of VF was successful in 84 patients as was a successful conversion on the first attempt in all. There were no procedure-related complications. During follow up one patient had two appropriate ICD shock events. In four patients, ICD programming was changed. None suffered inappropriate shock. There was no evidence of lead malfunction. Two deaths occurred, none of which was related to arrhythmia. CONCLUSION The present study found DT was not associated with complications in patients undergoing ICD generator replacement but produced no clinically important information.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Valentina Kutyifa
- University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 653 Rochester, NY 14642, USA
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Határőr street 18, Budapest, Hungary
| | - Ehud Regev
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Mauro Biffi
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy
| | - Yong-Mei Cha
- Mayo Clinic, 200 First St. SW Rochester, Minnesota 55905, USA
| | - Tal Ovdat
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
| | - Robert Klempfner
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
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2
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Hayase J, Do DH, Boyle NG. Defibrillation Threshold Testing: Current Status. Arrhythm Electrophysiol Rev 2018; 7:288-293. [PMID: 30588318 DOI: 10.15420/aer.2018.54.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/15/2018] [Indexed: 11/04/2022] Open
Abstract
When the transvenous ICD initially came into use for primary and secondary prevention of sudden cardiac death, defibrillation threshold (DFT) testing was universally performed. However, DFT testing is no longer routinely recommended for transvenous ICD implantation except in certain situations. Risk scores can help guide the decision to perform DFT testing. The subcutaneous ICD represents an area of uncertainty, with limited data available regarding the role of DFT testing in these devices. Current guidelines give a class I recommendation for performing DFT testing at the time of implant. Further studies are needed before this recommendation can be safely dismissed.
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Affiliation(s)
- Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
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3
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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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4
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The Selective Late Sodium Current Inhibitor Eleclazine, Unlike Amiodarone, Does Not Alter Defibrillation Threshold or Dominant Frequency of Ventricular Fibrillation. J Cardiovasc Pharmacol 2017; 69:178-182. [PMID: 28045761 DOI: 10.1097/fjc.0000000000000455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION We examined the effects of the selective late INa inhibitor eleclazine on the 50% probability of successful defibrillation (DFT50) before and after administration of amiodarone to determine its suitability for use in patients with implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS In 20 anesthetized pigs, transvenous active-fixation cardiac defibrillation leads were fluoroscopically positioned into right ventricular apex through jugular vein. ICDs were implanted subcutaneously. Dominant frequency of ventricular fibrillation was analyzed by fast Fourier transform. The measurements were made before drug administration (control), and at 40 minutes after vehicle, eleclazine (2 mg/kg, i.v., bolus over 15 minutes), or subsequent/single amiodarone administration (10 mg/kg, i.v., bolus over 10 minutes). Eleclazine did not alter DFT50, dominant frequency, heart rate, or mean arterial pressure (MAP). Subsequent amiodarone increased DFT50 (P = 0.006), decreased dominant frequency (P = 0.022), and reduced heart rate (P = 0.031) with no change in MAP. Amiodarone alone increased DFT50 (P = 0.005; NS compared to following eleclazine) and decreased dominant frequency (P = 0.003; NS compared to following eleclazine). CONCLUSION Selective late INa inhibition with eleclazine does not alter DFT50 or dominant frequency of ventricular fibrillation when administered alone or in combination with amiodarone. Accordingly, eleclazine would not be anticipated to affect the margin of defibrillation safety in patients with ICDs.
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5
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FRANCIA PIETRO, ADDUCI CARMEN, SEMPRINI LORENZO, PALANO FRANCESCA, SANTINI DARIA, MUSUMECI BEATRICE, SANTOLAMAZZA CATERINA, VOLPE MASSIMO, AUTORE CAMILLO. Prognostic Implications of Defibrillation Threshold Testing in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 28:103-108. [DOI: 10.1111/jce.13121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- PIETRO FRANCIA
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - CARMEN ADDUCI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - LORENZO SEMPRINI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - FRANCESCA PALANO
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - DARIA SANTINI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - BEATRICE MUSUMECI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - CATERINA SANTOLAMAZZA
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - MASSIMO VOLPE
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
- IRCCS Neuromed; Pozzilli (IS); Italy
| | - CAMILLO AUTORE
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
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6
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Phan K, Ha H, Kabunga P, Kilborn MJ, Toal E, Sy RW. Systematic Review of Defibrillation Threshold Testing at De Novo Implantation. Circ Arrhythm Electrophysiol 2016; 9:e003357. [DOI: 10.1161/circep.115.003357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
Background—
Recent results from the largest multicenter randomized trial (Shockless IMPLant Evaluation [SIMPLE]) on defibrillation threshold (DFT) testing suggest that while shock testing seems safe, it does not reduce the risk of failed shocks or prolong survival. A contemporary systematic review of DFT versus no-DFT testing at the time of implantable cardioverter–defibrillator implantation was performed to evaluate the current evidence and to assess the impact of the SIMPLE study.
Methods and Results—
Electronic searches were performed using 6 databases from their inception to March 2014. Relevant studies investigating implant DFT were identified. Data were extracted and analyzed according to predefined clinical end points. Predefined outcomes for interrogation were all-cause mortality, composite end point of implantable cardioverter–defibrillator efficacy (arrhythmic deaths and ineffective shocks), and composite safety end point (the sum of complications recorded at 30 days). Meta-analysis was performed including 13 studies and 9740 patients. No significant differences between DFT versus no-DFT cohorts were found in terms of all-cause mortality (risk ratio, 0.90; 95% confidence interval, 0.71–1.15;
P
=0.41), composite efficacy outcome (risk ratio, 1.24; 95% confidence interval, 0.65–3.37;
P
=0.51), and 30-day postimplant complications (risk ratio, 1.18; 95% confidence interval, 0.87–1.60;
P
=0.29). No significant difference was found in the trends observed when the results of the SIMPLE study were excluded or included.
Conclusions—
This systematic review of contemporary data suggests a modest average effect of DFT, if any, in terms of mortality, shock efficacy, or safety. Therefore, DFT testing should no longer be compulsory during de novo implantation. However, DFT testing may still be clinically relevant in specific patient populations.
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Affiliation(s)
- Kevin Phan
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Hakeem Ha
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Peter Kabunga
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Michael J. Kilborn
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Edward Toal
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Raymond W. Sy
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
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7
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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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8
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
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Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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9
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Okamura H, Friedman PA, Inoue Y, Noda T, Aiba T, Yasuda S, Ogawa H, Kamakura S, Kusano K, Espinosa RE. Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy. Circ J 2016; 80:2199-203. [DOI: 10.1253/circj.cj-16-0428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Division of Cardiovascular Diseases, Mayo Clinic
| | | | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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10
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Deif B, Healey JS. Complications of defibrillation testing. A review of the literature. Herzschrittmacherther Elektrophysiol 2015; 26:320-323. [PMID: 26621797 DOI: 10.1007/s00399-015-0404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 06/05/2023]
Abstract
Defibrillation testing (DT) has traditionally been performed at the time of implantable cardioverter defibrillator (ICD) insertion. However, there has been a trend away from conducting DT, in part due to observational studies showing uncommon but serious complications related to DT. More recently, several randomized trials have shown no improvement in the efficacy of clinical shocks among patients assigned to have DT. These trials also suggest a modest increase in perioperative complications related to DT; however, the overall rate of complications was very low. This review focuses on the prevalence of complications associated with DT and elaborates on a number of indications for DT.
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Affiliation(s)
- Bishoy Deif
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
- Population Health Research Institute, Hamilton, Ontario, Canada.
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11
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2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
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12
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Markewitz A. [Annual report 2013 of the German Cardiac Pacemaker And Defibrillator Register--Part 2: implantable cardioverter-defibrillators. Pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH workgroup]. Herzschrittmacherther Elektrophysiol 2015; 26:399-423. [PMID: 26446100 DOI: 10.1007/s00399-015-0398-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Markewitz
- Abt. XVII - Klinik für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
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13
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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14
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VISCHER ANNINAS, MUTSCHELKNAUSS MARCUS, KÜHNE MICHAELS, OSSWALD STEFAN, STICHERLING CHRISTIAN, SCHAER BEATA. Concurrent Cardioversion of Atrial Fibrillation during ICD Shock Testing. Pacing Clin Electrophysiol 2015; 38:864-9. [DOI: 10.1111/pace.12644] [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: 12/10/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 12/01/2022]
Affiliation(s)
- ANNINA S. VISCHER
- Division of Cardiology; University of Basel Hospital; Basel Switzerland
| | - MARCUS MUTSCHELKNAUSS
- Division of Cardiology; University of Basel Hospital; Basel Switzerland
- Herzpraxis Aeschenvorstadt; Basel Switzerland
| | - MICHAEL S. KÜHNE
- Division of Cardiology; University of Basel Hospital; Basel Switzerland
| | - STEFAN OSSWALD
- Division of Cardiology; University of Basel Hospital; Basel Switzerland
| | | | - BEAT A. SCHAER
- Division of Cardiology; University of Basel Hospital; Basel Switzerland
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15
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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.
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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
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16
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Phan K, Kabunga P, Kilborn MJ, Sy RW. Defibrillator Threshold Testing at Generator Replacement: Is it Time to Abandon the Practice? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:777-81. [PMID: 25790073 DOI: 10.1111/pace.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter Kabunga
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Kilborn
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raymond W Sy
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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17
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Feasibility and safety of a cardiologist-only approach to sedation for DFT testing. Int J Cardiol 2015; 179:11-2. [PMID: 25464393 DOI: 10.1016/j.ijcard.2014.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022]
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18
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Sorajja D, Munger TM, Shen WK. Optimal antiarrhythmic drug therapy for electrical storm. J Biomed Res 2015; 29:20-34. [PMID: 25745472 PMCID: PMC4342432 DOI: 10.7555/jbr.29.20140147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/05/2014] [Indexed: 01/08/2023] Open
Abstract
Electrical storm, defined as 3 or more separate episodes of ventricular tachycardia or ventricular fibrillation within 24 hours, carries significant morbidity and mortality. These unstable ventricular arrhythmias have been described with a variety of conditions including ischemic heart disease, structural heart disease, and genetic conditions. While implantable cardioverter defibrillator implantation and ablation may be indicated and required, antiarrhythmic medication remains an important adjunctive therapy for these persons.
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Affiliation(s)
- Dan Sorajja
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Thomas M Munger
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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19
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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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20
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Markewitz A. [Annual Report 2012 of the German Heart pacemaker defibrillator round register: Section on pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH]. Herzschrittmacherther Elektrophysiol 2014; 25:284-312. [PMID: 24965923 DOI: 10.1007/s00399-014-0319-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Markewitz
- Klinik für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus, Rübenacher Str. 170, 56072, Koblenz, Deutschland,
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22
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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.)
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23
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HADID CLAUDIO, DI TORO DARÍO, GALLINO SEBASTIÁN, LABADET CARLOS. Should We Test All Defibrillators at the Time of Implantation? An Unanswered Question. J Cardiovasc Electrophysiol 2013; 24:E18. [DOI: 10.1111/jce.12263] [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: 11/29/2022]
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24
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SCHAER BEATA, VISCHER ANNINAS. Reply to the Letter of Hadid et al
. J Cardiovasc Electrophysiol 2013; 24:E19. [DOI: 10.1111/jce.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- BEAT A. SCHAER
- Department of Cardiology; University of Basel Hospital; Basel Switzerland
| | - ANNINA S. VISCHER
- Department of Cardiology; University of Basel Hospital; Basel Switzerland
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25
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Markewitz A. [Annual Report 2011 of the German pacemaker and defibrillator register: Section pacemakers and AQUA-Institute for Applied Quality Improvement and Research in Health Care]. Herzschrittmacherther Elektrophysiol 2013; 24:249-74. [PMID: 24065137 DOI: 10.1007/s00399-013-0288-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Markewitz
- Abt. XVII - Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus, Rübenacher Str. 170, 56072, Koblenz, Deutschland,
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26
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Bokeria L, Filatov A, Kovalev A. eComment. Shock or no shock: individual option for some patients. Interact Cardiovasc Thorac Surg 2013; 16:325-6. [PMID: 23400534 DOI: 10.1093/icvts/ivs578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leo Bokeria
- Bakoulev Center for Cardiovascular Surgery Russian Academy of Medical Sciences, Moscow, Russia
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