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Predictors of a high defibrillation threshold test during routine ICD implantation
- Source :
- Acta cardiologica; May 2018, Vol. 73 Issue: 3 p267-273, 7p
- Publication Year :
- 2018
-
Abstract
- AbstractBackground:There is growing evidence that routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation is not necessary. However a small group of patients might be at risk if no DFT testing is performed.Methods:Patients with a new pectoral ICD implantation in our hospital between 2006 and 2014 were included in a retrospective registry. A clinical high DFT was defined as a safety margin <10 J of the maximal device output. Logistic regression for prediction of high DFT was performed using patient characteristics, clinical, echocardiographic and device-related parameters.Results:DFT testing was performed in 788/864 (91.2%) procedures. In 76 (8.8%) patients no DFT testing was performed mainly due to atrial fibrillation, intra-cardiac thrombus, hemodynamic instability or logistical reasons. A high DFT was present in 44 (5.6%) patients. A QRS duration ≥150 ms, a low left ventricular ejection fraction (LVEF ≤25%), a severely dilated left ventricle ≥60 mm and right sided pre-pectoral implantations were univariate predictors of a high DFT. Independent predictors of a high DFT were a LVEF ≤25% (HR 2.195, 95%CI 1.085–4.443) and right sided pre-pectoral implantations (HR 3.135, 95% CI 1.186–8.287).Conclusions:A high DFT is still present in about 5% of patients and is more frequent in patients with a severely dilated left ventricle, a very low LVEF, right sided pre-pectoral implantation and wider QRS duration. It might be clinically important to continue DFT testing in these high risk patients.
Details
- Language :
- English
- ISSN :
- 00015385 and 1784973X
- Volume :
- 73
- Issue :
- 3
- Database :
- Supplemental Index
- Journal :
- Acta cardiologica
- Publication Type :
- Periodical
- Accession number :
- ejs45797211
- Full Text :
- https://doi.org/10.1080/00015385.2017.1371455