In a large patient cohort receiving ICDs for primary or secondary prevention, the adoption of novel enhanced detection algorithms in conjunction with routine implementation of modern programming strategies led to a very low inappropriate shock rate.

Dual antiplatelet therapy and periprocedural heparin significantly increase the risk of bleeding complications at the time of pacemaker or ICD implantation.

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CT images aid in the diagnosis of lead perforation when other modalities are nondiagnostic. Recent advances in CT technology have been associated with increased use of this technique for evaluation of chest pain, analysis of which should now include location of intracardiac leads.

Background-Survival after prolonged ventricular fibrillation (VF) appears severely limited by 2 major factors: (1) low defibrillation success rates and (2) persistent post-countershock myocardial dysfunction. Biphasic (BP) waveforms may prove capable of favorably modifying these limitations. However, they have not been rigorously tested against monophasic (MP) waveforms in clinical models of external defibrillation, particularly where rescue from prolonged VF is the general rule. Methods and Results-We randomized 26 dogs to external countershocks with either MP or BP waveforms.Hemodynamics were assessed after shocks applied during sinus rhythm, after brief VF (Ͼ10 seconds), and after resuscitation from prolonged VF (Ͼ10 minutes). Short-term differences in percent change in left ventricular ϩdP/dt max (MP Ϫ16Ϯ28%, BP ϩ9.1Ϯ24%; Pϭ0.03) and left ventricular ϪdP/dt max (MP Ϫ37Ϯ26%, BP Ϫ18Ϯ20%; Pϭ0.05) were present after rescue from brief VF, with BP animals exhibiting less countershock-induced dysfunction. After prolonged VF, the BP group had lower mean defibrillation thresholds (107Ϯ57 versus 172Ϯ88 J for MP, Pϭ0.04) and significantly shorter resuscitation times (397Ϯ73.7 versus 488Ϯ74.3 seconds for MP, Pϭ0.03). Conclusions-External defibrillation is more efficacious with BP countershocks than with MP countershocks. The lower defibrillation thresholds and shorter resuscitation times associated with BP waveform defibrillation may improve survival after prolonged VF arrest.