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Defibrillation Testing (defibrillation + testing)
Is Defibrillation Testing Still Necessary?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
A Decision Analysis, Markov Model
Objective: To assess the impact of defibrillation threshold (DFT) testing of implanted cardioverter-defibrillators (ICDs) on survival. Background: DFT testing is generally performed during implantation of ICDs to assess sensing and termination of ventricular fibrillation. It is common clinical practice to defibrillate ventricular fibrillation twice at an output at least 10 J below the maximum output of the device, providing a 10 J safety margin. However, there are few data regarding impact of DFT testing on outcomes. Methods: Decision analysis and Monte Carlo simulation were used to assess expected outcomes of DFT testing. Survival of a hypothetical cohort of patients was assessed according to two strategies,routine DFT testing at time of ICD implant versus no DFT testing. Assumptions in the model were varied over a range of reasonable values to assess outcomes under a variety of scenarios. Results: Five-year survival with DFT and no-DFT strategies were similar at 59.72% and 59.36%, respectively. The results were not sensitive to changing risk estimates for arrhythmia incidence and safety margin. Results of the Monte Carlo simulation were qualitatively similar to the base case scenario and consistent with a small and nonsignificant survival advantage with routine DFT testing. Conclusions: The impact of DFT testing on 5-year survival in ICD patients, if it exists, is small. Survival appears higher with DFT testing as long as annual risk of lethal arrhythmia or the risk of a narrow safety margin is at least 5%, although the incremental benefit is marginal and 95% confidence intervals cross zero. A prospective randomized study of DFT testing in modern devices is warranted. [source]
Defibrillation Testing at ICD Implantation: Are We Asking the Wrong Question?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2009
MICHAEL R. GOLD M.D., Ph.D.
No abstract is available for this article. [source]
Two Hearts and One DefibrillatorJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2004
PETER OTT M.D.
A patient who had undergone heterotopic heart transplantation and placement of an implantable cardioverter defibrillator in his native heart underwent generator change. Defibrillation testing induced ventricular fibrillation in his donor heart. To prevent this potentially lethal complication, defibrillator shock therapy must be synchronized to the donor heart R wave. [source]
Endocardial Implantation of a Cardioverter Defibrillator in Early ChildhoodJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005
MAURIZIO GASPARINI M.D.
Introduction: Experience in endovascular/endocardial techniques for implanting implantable cardioverter defibrillators in early childhood is limited. Potentially, this type of approach could limit the surgical risk, while increasing ICD therapy efficacy. The safety and feasibility of adopting a complete endovascular/endocardial approach for implanting ICDs is assessed by considering the cases of two young children. Methods and Results: Two boys, aged 3 and 6 years, were implanted with ICD for a history of syncope and documented ventricular tachycardia (VT). A complete endovascular/endocardial approach was adopted consisting of positioning a bipolar pacing and sensing lead in the right ventricular (RV) apex with intravascular redundancy forming a loop in the inferior vena cava (IVC), and a caval coil placed in the IVC. Sensing values (7,8 mV), pacing threshold (0.5,0.6 V/0.5 msec), and defibrillation testing (case 1 = 10 J, case 2 = 20 J) were all acceptable. During follow-up, in both cases ICD intervened correctly. In one case, 16 months after implantation, because of change in the IVC coil-active can vector, the IVC coil was effectively repositioned to a more distal position. Conclusion: A complete endovascular/endocardial ICD implantation technique in early childhood is both feasible and safe. This approach avoids thoracotomy and ensures ICD therapy efficacy. [source]