Impact of defibrillation testing on predicted ICD shock efficacy: Implications for clinical practice

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…The authors concluded that defibrillation efficacy without DT was noninferior to ICD implantation with DT in left-sided ICD implants. Because no major benefit or harm associated with DT was detected, in patients with a leftsided pectoral implantation it is reasonable to omit routine VF induction and DT during ICD implantation, assuming stable ICD lead position and good sensing and capture function [217][218][219][220]. This approach is particularly applicable to patients with ischemic and idiopathic dilated cardiomyopathy, given these entities were well represented in the studied cohort.…”

Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial

“… 7 , 8 System modifications, such as repositioning of the electrode, reversal of polarity, use of a high-energy device, use of a dual instead of a single-coil electrode, or the implantation of an additional subcutaneous electrode, may be unnecessary or even harmful since many patients have a successful retesting with the original system configuration. 9 No single system modification in itself has ever been shown to improve outcome. 10 With current devices and programming, an inadequate safety margin occurs infrequently, 11 and the incidence of ventricular tachyarrhythmias requiring shocks is low at 4–6% per year.…”

Clinical Impact, Safety, and Efficacy of Single‐ versus Dual‐Coil ICD Leads in MADIT‐CRT

“…However, small differences in defibrillation threshold are less likely to be clinically meaningful with today's high energy ICD devices . Some studies also suggested that defibrillation threshold does not reflect therapy efficacy (shock conversion rate) during the follow‐up . Furthermore, dual‐coil ICD leads have more complicated lead structure that might be associated with higher risk of lead‐related complications including lead dislodgement, insulation failure or lead fracture that need lead extraction …”