Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2017; 9(2): 167-173
Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.167
Critical analysis of ineffective post implantation implantable cardioverter-defibrillator-testing
Markus Roos, J Christoph Geller, Marc-Alexander Ohlow
Markus Roos, Heart Center, Salzburger Leite, 97616 Bad Neustadt a.d. Saale, Germany
J Christoph Geller, Marc-Alexander Ohlow, Zentralklinik Bad Berka, Division of Cardiology, Robert Koch Allee, 99437 Bad Berka, Germany
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: Data were assessed for quality assurance. Retrospective analysis of these data is accepted without the approval of a review board in our institution.
Informed consent statement: Patient’s agreement with retrospective analysis of their data is included in the initial agreement on admission to the hospital. There is no informed consent statement for this retrospective analysis of patients file.
Conflict-of-interest statement: No conflicts of interests of any of the authors have to be declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Markus Roos, MSc, MD, Heart Center, Salzburger Leite, 97616 Bad Neustadt a.d. Saale, Germany. roosmarkus@bluewin.ch
Telephone: +49-9771-662602 Fax: +49-9771-65982602
Received: August 8, 2016
Peer-review started: August 8, 2016
First decision: September 12, 2016
Revised: October 30, 2016
Accepted: November 27, 2016
Article in press: November 29, 2016
Published online: February 26, 2017
Processing time: 199 Days and 14.6 Hours
Abstract
AIM

To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.

METHODS

All consecutive patients between January 2006 and December 2008 undergoing implantable cardioverter-defibrillator (ICD) implantation/replacement (a total of 634 patients) were included in the retrospective study.

RESULTS

Sixteen patients (2.5%) were not tested (9 with LA/LV-thrombus, 7 due to operator’s decision). Analyzed were 618 patients [76% men, 66.4 + 11 years, 24% secondary prevention (SP), 46% with left ventricular ejection fraction (LVEF) < 20%, 56% had coronary artery disease (CAD)] undergoing defibrillation safety testing (SMT) with an energy of 21 + 2.3 J. In 22/618 patients (3.6%) induced ventricular fibrillation (VF) could not be terminated with maximum energy of the ICD. Six of those (27%) had successful SMT after system modification or shock lead repositioning, 14 patients (64%) received a subcutaneous electrode array. Younger age (P = 0.0003), non-CAD (P = 0.007) and VF as index event for SP (P = 0.05) were associated with a higher incidence of ineffective SMT. LVEF < 20% and incomplete revascularisation in patients with CAD had no impact on SMT.

CONCLUSION

Defibrillation testing is well-tolerated. An ineffective SMT occurred in 4% and two third of those needed implantation of a subcutaneous electrode array to pass a SMT > 10 J.

Keywords: Implantable cardioverter defibrillator; Implantable cardioverter-defibrillator; Sudden cardiac death; Defibrillation test; Safety margin test; Ventricular fibrillation; Subcutaneous electrode array

Core tip: The implantable cardioverter defibrillator is crucial for primary and secondary prevention of severe life-threatening ventricular tachyarrhythmia. However the importance concerning intra-operative defibrillation testing and clinical relevance of inadequate testing of implantable cardioverter-defibrillator (ICD) devices remains still under debate. In this study, we analyzed our singe-center data of patients undergoing ICD implantation or replacement to determine the number of failed internal defibrillation testing at the time of ICD implantation and the consequences for management. We critically reflect the progressive trend to omit defibrillation testing at the time of ICD placement.