Intraoperative defibrillation threshold testing and postoperative long-term efficacy of cardioverter-defibrillator implantation

Gan,Tianyi; Cao,Xiaozhi; Yu,Zhang; Tang,Baopeng; Li,Jinxin; Xu,Guojun; Zhou,Xianhui; Zhang,Yanyi; Li,Yaodong; Zhang,Jianghua

doi:10.3892/etm.2012.797

Intraoperative defibrillation threshold testing and postoperative long-term efficacy of cardioverter-defibrillator implantation

Authors:
- Tianyi Gan
- Xiaozhi Cao
- Zhang Yu
- Baopeng Tang
- Jinxin Li
- Guojun Xu
- Xianhui Zhou
- Yanyi Zhang
- Yaodong Li
- Jianghua Zhang
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Affiliations: Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China, Department of Cardiology, Fuzhou General Hospital, Nanjing Command, PLA, Fuzhou 350025, P.R. China, Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
Published online on: November 5, 2012 https://doi.org/10.3892/etm.2012.797
Pages: 323-327

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Abstract

The aim of this study was to determine the defibrillation threshold (DFT) of implantable cardioverter-defibrillators (ICDs) and outcomes of treatment. Sixty-four patients received cardioverter-defibrillator implantation. During implantation, the DFT was determined by the defibrillation safety margin (DSM). All patients were followed up for 12-48 months after the implantation. The overall DFT was 14.27±2.56 J and the DSM was 18.40±1.89 J. Malignant ventricular arrhythmias occurred in 42 patients following cardioverter-defibrillator implantation including 500 episodes of non-sustained ventricular tachycardia (VT) and 289 episodes of persistent VT. VT was treated using antitachycardia pacing (ATP); 265 episodes were treated successfully by a single ATP treatment (91.69%) and 12 episodes were treated successfully by two ATP treatments (4.15%). Twelve episodes were converted by low-energy electrical cardioversion (4.15%). A total of 175 ventricular fibrillation (VF) episodes were identified, of which 18 episodes automatically terminated prior to treatment. In total, 146 episodes were converted by a single cardioversion with a defibrillation energy of 13.21±2.58 J and 11 episodes were converted by two cardioversions with a defibrillation energy of 16.19±2.48 J. It is safe and feasible to determine the DFT by DSM measurement during cardioverter-defibrillator implantation.

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1	Birnie D, Tung S, Simpson C, et al: Complications associated with defibrillation threshold testing: the Canadian experience. Heart Rhythm. 5:387–390. 2008. View Article : Google Scholar : PubMed/NCBI
2	Brignole M, Raciti G, Bongiorni MG, et al: Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey. Europace. 9:540–543. 2007. View Article : Google Scholar : PubMed/NCBI
3	Sandstedt B, Gottfridsson C, Nyström B and Edvardsson N: Testing the implantable cardioverter-defibrillator after implantation - is it necessary? Pacing Clin Electrophysiol. 30:985–991. 2007. View Article : Google Scholar : PubMed/NCBI
4	Swerdlow CD, Shehata M and Chen PS: Using the upper limit of vulnerability to assess defibrillation efficacy at implantation of ICDs. Pacing Clin Electrophysiol. 30:258–270. 2007. View Article : Google Scholar : PubMed/NCBI
5	Strickberger SA and Klein GJ: Is defibrillation testing required for defibrillator implantation? J Am Coll Cardiol. 44:88–91. 2004. View Article : Google Scholar : PubMed/NCBI
6	Hall B, Jeevanantham V, Levine E, et al: Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing. Cardiol J. 14:463–469. 2007.
7	Liu QM, Bai ZL, Liu ZJ, Li XP and Zhou SH: Defibrillation threshold testing: is it necessary during implantable cardioverter-defibrillator implantation? Med Hypotheses. 72:147–149. 2009. View Article : Google Scholar : PubMed/NCBI
8	Swerdlow CD, Russo AM and Degroot PJ: The dilemma of ICD implant testing. Pacing Clin Electrophysiol. 30:675–700. 2007. View Article : Google Scholar : PubMed/NCBI
9	Kirilmaz A, Dokumaci B, Uzun M, et al: Detection of the defibrillation threshold using the upper limit of vulnerability following defibrillator implantation. Pacing Clin Electrophysiol. 28:498–505. 2005. View Article : Google Scholar : PubMed/NCBI
10	Bardy GH, Poole JE, Kudenchuk PJ, Dolack GL, Mehra R, DeGroot P, Raitt MH, Jones GK and Johnson G: A prospective randomized comparison in humans of biphasic waveform 60-microF and 120-microF capacitance pulses using a unipolar defibrillation system. Circulation. 91:91–95. 1995. View Article : Google Scholar
11	Viskin S and Rosso R: The top 10 reasons to avoid defibrillation threshold testing during ICD implantation. Heart Rhythm. 5:391–393. 2008. View Article : Google Scholar : PubMed/NCBI
12	Pires LA and Johnson KM: Intraoperative testing of the implantable cardioverter-defibrillator: how much is enough? J Cardiovasc Electrophysiol. 17:140–145. 2006. View Article : Google Scholar : PubMed/NCBI
13	Russo AM, Sauer W, Gerstenfeld EP, et al: Defibrillation threshold testing: Is it really necessary at the time of implantable cardioverter-defibrillator insertion? Heart Rhythm. 2:456–461. 2005. View Article : Google Scholar : PubMed/NCBI
14	Mainigi SK and Callans DJ: How to manage the patient with a high defibrillation threshold. Heart Rhythm. 3:492–495. 2006. View Article : Google Scholar : PubMed/NCBI
15	Uyguanco ER, Berger A, Budzikowski AS, Gunsburg M and Kassotis J: Management of high defibrillation threshold. Expert Rev Cardiovasc Ther. 6:1237–1248. 2008. View Article : Google Scholar : PubMed/NCBI
16	Littmann L and Rennyson SL: Electrical storm: clinical manifestations and management. Minerva Med. 98:489–501. 2007.PubMed/NCBI
17	Exner DV, Pinski SL, Wyse DG, et al AVID Investigators: Antiarrhythmics Versus Implantable Defibrillators: Electrical storm presages non-sudden death: the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation. 103:2066–2071. 2001. View Article : Google Scholar
18	Cai F, Chen S and Gu G: The clinical application of implantable cardioverter-defibrillator in ventricular tachyarrhythmias. J Intervent Cardiol. 17:89–91. 2009.(In Chinese).
19	Wang DM, Han YL and Zang HY: Long-term efficacy of revascularization combined with implantable cardioverter-defibrillator in patients with coronary heart disease. Shenyang Military Med. 21:3–5. 2008.(In Chinese).
20	Israel CW and Barold SS: Electrical storm in patients with an implanted defibrillator: a matter of definition. Ann Noninvasive Electrocardiol. 12:375–382. 2007. View Article : Google Scholar : PubMed/NCBI
21	Gradaus R, Block M, Brachmann J, et al: Mortality, morbidity, and complications in 3344 patients with implantable cardioverter defibrillators: results from the German ICD Registry EURID. Pacing Clin Electrophysiol. 26:1511–1518. 2003. View Article : Google Scholar : PubMed/NCBI