Journal Article

Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey

Michele Brignole, Giovanni Raciti, Maria Grazia Bongiorni, Giuseppe De Martino, Stefano Favale, Maurizio Gasparini, Raffaele Luise, Eraldo Occhetta and A. Proclemer

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 7, pages 540-543
Published in print July 2007 | ISSN: 1099-5129
Published online May 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum083
Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey

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Aims Despite an effective defibrillation testing (DT) is considered mandatory to be consistent with the rules of good clinical practice, some physicians are concerned about the risk of complications related to the induction test, and in real world clinical practice, several implant procedures are performed without any induction test. We conducted a systematic nation-wide retrospective survey in order to determine the DT rate and its complications.

Methods and results An ad hoc questionnaire was sent to all 343 Italian implanting centres and the data from the 229 (67%) centres that answered were analysed. During the year 2005, a total of 7857 patients underwent a first implantation of cardioverter defibrillator (ICD), 38% of which with cardiac resynchronization therapy (CRT). Of these, 2356 (30%) were implanted without any induction test. In 35 (15%) centres, the induction test was performed in < 25% of the patients, whereas in 136 (59%) centres, it was performed in > 75% of the patients. At multivariable analysis, performed in a subset of 1206 patients from 107 centres, CRT device (OR = 1.82) and primary prevention (OR = 1.47) were independent predictors of the decision to not perform DT. However, altogether, the clinical variables accounted only for 35% of the total variance, whereas the remaining 65% was probably unrelated to clinical factors. There was a total of 22 (0.4%) life-threatening complications as a consequence of the induction test: 4 deaths (0.07%), 8 cardiopulmonary arrests requiring resuscitation manoeuvres (0.15%), 6 cardiogenic shocks (0.11%), 3 strokes (0.05%), and 1 pulmonary embolism (0.02%).

Conclusion In real world practice, DT is not performed in a substantial number of patients, most of these in the absence of legitimate reasons. The clinical impact of DT vs. no DT remains unclear until the not negligible complication rate is compared against the long-term potential benefit.

Keywords: Defibrillation testing; Implantable cardioverter defibrillator; Ventricular fibrillation

Journal Article.  2643 words.  Illustrated.

Subjects: Cardiovascular Medicine

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