Key PointsQuestionWhat are contemporary trends, institutional variation, and patient and hospital characteristics associated with defibrillation testing among patients undergoing first-time implantable cardioverter-defibrillator implantation?FindingsIn this cross-sectional study of 499 211 patients undergoing implantable cardioverter-defibrillator implantation, there was a significant decline in the use of defibrillation testing, yet there was a marked increase in institutional variation.MeaningThere is variability in the deadoption of defibrillation testing which is not based on patient characteristics and could reflect differences in individual or institutional practices.

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