Predictors of High Defibrillation Threshold in Patients With Implantable Cardioverter-Defibillator Using a Transvenous Dual-Coil Lead

Yokoshiki, Hisashi; Makino, Hírofumi; Watanabe, Masaya; Tenma, Taro; Matsui, Yoshiro; Tsutsui, Hiroyuki

doi:10.1253/circj.cj-14-0860

Cited by 16 publications

(12 citation statements)

References 41 publications

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“…As shown in Table III, the patients with clinical events had a significantly lower LVEF (P < 0.001), lower estimated glomerular filtration rate (eGFR) (P = 0.034), greater occurrence of AF (P = 0.035), and a higher DFT (P < 0.001) as compared to the event-free group. In order to THE RELATIONSHIP BETWEEN DFT AND CLINICAL OUTCOME [16][17][18] In contrast to previous studies, we could not find the significant difference between the high DFT and non-high DFT groups. This is because the present study included a smaller number of patients compared to previous studies, and the difference may not be statistically significant.…”

Section: Resultscontrasting

confidence: 99%

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Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

et al. 2017

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SummaryDefibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantations is considered necessary for appropriate shock therapy and to measure the safety margin. However, the relationship between the DFT with modern era devices and the clinical outcome, including the total mortality is limited, which may lead to DFT testing itself being questioned. This study aimed to evaluate the relationship between the DFT and clinical outcome in ICD recipients.We enrolled 81 consecutive patients (66 males, aged 64.6 ± 13.8 years) who received an ICD implantation and underwent DFT testing. The DFT was measured with a step-by-step method in the patients upon implant. Further, we evaluated the relationship between the DFT and the clinical outcome, which included major cardiac adverse events and any cause of death.The mean DFT was 11.6 ± 9.24J in total. In 40 patients (49.4%), VF was terminated by a low output (5J), whereas 11 patients (13.6%) had a high DFT. The rates of atrial fibrillation were significantly higher in the high DFT group (63.6% versus 24.2%, P = 0.007). During the observational period (median 432 days; range from 151 days to 1146 days), the incidence of clinical events occurred in 22 patients (27.2%) in total. In a multivariate analysis, a high DFT was the only predictive factor for the incidence of the clinical outcome (OR 4.54, 95% CI 1.03-21.9, P = 0.045).(Int Heart J 2017; 58: 874-879) Key words: Defibrillation threshold testing, Major adverse cardiac events, High DFT I mplantable cardioverter defibrillators (ICDs) have been shown to reduce the total mortality when used for the primary and secondary prevention of sudden cardiac death (SCD). 1,2) Therefore, ICD implantations play a key role in patients who have a risk of SCD. Defibrillation threshold (DFT) testing is performed after the ICD implantation to assure adequate sensing and defibrillation of ventricular fibrillation (VF). However, previous reports showed that the DFT testing during ICD implantations is neither effective nor beneficial. 3-9) The SIMPLE trial 10) is a single-blind, randomized, multicenter, non-inferiority trial comparing the efficacy and safety of ICD implantations with DFT or without DFT testing. Recently it demonstrated that a routine DFT test at the time of the ICD implantation does not improve shock efficacy or reduce arrhythmic death. However, Ziegelhoeffer, et al. reported that intraoperative DFT testing might still be recommended because the previous prospective clinical trials were limited to de novo implants of high-energy generators and neglected a large number of patients already implanted with an ICD system. 11) Furthermore, the determination of the actual DFT enables lower energy shocks and thus potentially reduces the energy required for defibrillation, shortens the charging time, reduces the risk of loss of consciousness, and decreases the myocardial damage.In the present study, we enrolled various types of ICD recipients (an initial ICD or cardiac resynchronization therapy devices...

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Section: Resultscontrasting

confidence: 99%

“…In this regard, the mean LVEF was relatively higher than in past studies. 17,18) The heterogeneous patient population in our study could have negated the possible involvement of LVEF as a predictor of high DFT. There are limited data on the prognostic significance of an elevated DFT.…”

Section: Resultsmentioning

confidence: 93%

Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

et al. 2017

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“…Mizukami et al found that an interventricular septal thickness of more than 12 mm was an independent predictor for high DFT in transvenous ICD systems. 16 Given that the shock vector of the S-ICD system is between the left lateral and anterior chest walls, it is plausible that insufficient energy delivery occurs with increased septal and posterior wall mass, resulting in a failure to defibrillate.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Elevated Defibrillation Threshold with the Subcutaneous Implantable Cardioverter-defibrillator

Chang

Konečný

et al. 2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. There are limited data regarding defibrillation thresholds (DFTs) for the subcutaneous implantable cardioverter-defibrillator (S-ICD), and factors associated with elevated DFTs remain incompletely understood. The objective of this study was to determine the factors associated with elevated DFTs in patients undergoing S-ICD implantation. A retrospective cross-sectional analysis of all patients undergoing S-ICD implantation at our institution between 2013 and 2016 who underwent step-down DFT testing was performed. Factors associated with a higher DFT were analyzed. In total, 56 patients (mean age: 49.3 ± 13.1 years, mean left ventricular ejection rate: 31.1% ± 13.7%) underwent S-ICD implantation in the study period. Full DFT testing was performed in 31 of the 56 patients (55%), with an average DFT of 46.4 joules (J) ± 25.9 J found among this cohort. The DFT was 4 65 J in five of the 31 patients (16%). A high DFT was associated with increased body mass index (BMI) (37.7 kg/m 2 versus 29.4 kg/m 2 ; p ¼ 0.02) and either increased septal or posterior wall thickness (1.5 cm versus 1.0 cm; p ¼ 0.0003 and 1.4 cm versus 1.1 cm; p ¼ 0.003, respectively). Patients with high DFTs also had higher failed shock impedance values (138 O versus 71 O; p ¼ 0.005). Renal failure did not appear to affect DFT (51.4 J versus 51.7 J; p ¼ 0.99). BMI, body surface area (BSA), and septal and posterior left ventricular wall thickness predicted elevated DFT on univariate analysis, although findings were not significant with multivariate analysis due to the small sample size. Thus, elevated S-ICD DFT appears to be associated with increased BMI, BSA, and septal or posterior wall thickness. In contrast, dialysis-dependent renal failure is not associated with elevated DFT. Further investigation is necessary in order to better characterize and predict which patients are at-risk for high DFTs.

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“…25 Many studies have found associations with factors such as QRS duration, antiarrhythmic use, atrial fibrillation, and heart size with elevated DFT, yet no validated predictive model currently exists. [26][27][28][29] It is likely that the elevated DFTs in our study were influenced by many of these same factors, which affect the non-congenital population. Still, care should be taken in these patients.…”

Section: Discussionmentioning

confidence: 82%

Pacemaker and Defibrillation Implantation in Patients with Transposition of the Great Arteries

Grubb

Shah

Aziz

et al. 2017

JICRM

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Predictors of High Defibrillation Threshold in Patients With Implantable Cardioverter-Defibillator Using a Transvenous Dual-Coil Lead

Cited by 16 publications

References 41 publications

Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

Predictors of Elevated Defibrillation Threshold with the Subcutaneous Implantable Cardioverter-defibrillator

Pacemaker and Defibrillation Implantation in Patients with Transposition of the Great Arteries

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