Defibrillation Threshold Testing for Right-sided Device Implants: A Review to Inform Shared Decision-making, in Association with the British Heart Rhythm Society

Prevention of sudden death using ICDs requires the reliable delivery of a high-energy shock to successfully terminate VF. Until more recently, the device implant procedure included conducting defibrillation threshold (DFT) testing involving VF induction and shock delivery to ensure efficacy. Large c...

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Bibliographic Details
Published in:Arrhythmia & electrophysiology review 2023-01, Vol.12, p.e10-e10
Main Authors: Pope, Michael Tb, Paisey, John R, Roberts, Paul R
Format: Article
Language:English
Subjects:
Cardiac arrhythmia
Cardiomyopathy
Decision making
Defibrillators
Design
Electric countershock
Energy
Heart beat
Implantable Devices
Medical research
Medicine, Experimental
Mortality
Prevention
Shock
Transplants & implants
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Summary:Prevention of sudden death using ICDs requires the reliable delivery of a high-energy shock to successfully terminate VF. Until more recently, the device implant procedure included conducting defibrillation threshold (DFT) testing involving VF induction and shock delivery to ensure efficacy. Large clinical trials, including SIMPLE and NORDIC ICD, have subsequently demonstrated that this is unnecessary, with a practice of omitting DFT testing having no impact on subsequent clinical outcomes. However, these studies specifically excluded patients requiring devices implanted on the right side, in whom the shock vector is significantly different and smaller studies suggest a higher DFT. In this review, the data regarding the use of DFT testing, focusing on right-sided implants, and the results of a survey of current UK practice are presented. In addition, a strategy of shared decision-making when it comes to deciding on the use of DFT testing during right-sided ICD implant procedures is proposed.
ISSN:2050-3369
2050-3377
DOI:10.15420/aer.2022.38