Incidence of very high defibrillation thresholds (DFT) and efficacy of subcutaneous (SQ) array insertion during implantable cardioverter defibrillator (ICD) implantation

Background The incidence, risk factors, and management of very high defibrillation thresholds (DFTs) during present-day implantable cardioverter defibrillator (ICD) testing are not well known. Objectives The purpose of this study was to assess (1) the incidence of very high DFTs and (2) the efficacy...

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Bibliographic Details
Published in:Journal of interventional cardiac electrophysiology 2010-11, Vol.29 (2), p.127-133
Main Authors: Verma, Atul, Kaplan, Alexander J., Sarak, Bradley, Oosthuizen, Richard, Beardsall, Marianne, Higgenbottam, Jan, Wulffhart, Zaev, Khaykin, Yaariv
Format: Article
Language:English
Subjects:
Canada - epidemiology
Cardiology
Defibrillators, Implantable - statistics & numerical data
Electrodes, Implanted - statistics & numerical data
Equipment Failure - statistics & numerical data
Female
Heart Failure - epidemiology
Heart Failure - prevention & control
Humans
Incidence
Male
Medicine
Medicine & Public Health
Middle Aged
Treatment Outcome
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Summary:Background The incidence, risk factors, and management of very high defibrillation thresholds (DFTs) during present-day implantable cardioverter defibrillator (ICD) testing are not well known. Objectives The purpose of this study was to assess (1) the incidence of very high DFTs and (2) the efficacy/safety of routinely adding a subcutaneous (SQ) array for these patients. Methods The study evaluated patients undergoing first-time ICD implantation at Southlake Regional Healthcare Centre from January 2006 to December 2007. All implanted ICDs had a maximal output of 35 J. Patients with DFTs greater than a 10-J safety margin from maximum output were considered to have very high readings and underwent SQ array insertion after other attempts at lowering DFT (group I). These patients were compared with the rest of the patients who had acceptable DFTs (group II) using both univariate and multivariate logistic regression analysis. Outcomes of array insertion were also assessed. Results A total of 313 patients underwent first-time ICD implantation during the analysis period. Of those, 16 (5.1%) had very high DFTs (group I). By univariate analysis, advanced New York Heart Association class (3 or 4), congestive heart failure hospitalization, non-ischemic cardiomyopathy, amiodarone use, implant of a biventricular device, and highest quartile of left ventricular (LV) chamber enlargement were all significant predictors of very high DFTs ( p  
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-010-9511-7