The Population Health Research Institute, McMaster University, Hamilton, Canada.
J Cardiovasc Electrophysiol. 2010 Feb;21(2):177-82. doi: 10.1111/j.1540-8167.2009.01616.x. Epub 2009 Oct 5.
There is uncertainty about the proper role of defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion.
A prospective registry was conducted at 13 sites in Canada between January 2006 and October 2007.
To document the details of DT, the reasons for not conducting DT, and the costs and complications associated with DT.
DT was conducted at implantation in 230 of 361 patients (64%). DT was more likely to be conducted for new implants compared with impulse generator replacements (71% vs 32%, P = 0.0001), but was similar for primary and secondary prevention indications (64% vs 63%, P = NS). Among patients not having DT, the reason(s) given were: considered unnecessary (44%); considered unsafe, mainly due to persistent atrial fibrillation (37%); lack of an anesthetist (20%); and, patient or physician preference (6%). When performed, DT consisted of a single successful shock > or = 10J below maximum device output in 65% of cases. A 10J safety-margin was met by 97% of patients, requiring system modification in 2.3%. Major perioperative complications occurred in 4.4% of patients having DT versus 6.6% of patients not having DT (P = NS). ICD insertion was $844 more expensive for patients having DT (P = 0.16), largely due to increased costs ($28,017 vs $24,545) among patients having impulse generator replacement (P = 0.02).
DT was not performed in a third of ICD implants, usually due to a perceived lack of need or relative contraindication.
在植入式心脏复律除颤器 (ICD) 植入时，除颤测试 (DT) 的适当作用尚不确定。
2006 年 1 月至 2007 年 10 月期间，在加拿大的 13 个地点进行了一项前瞻性登记。
记录 DT 的详细信息、不进行 DT 的原因以及与 DT 相关的成本和并发症。
在 361 名患者中的 230 名（64%）在植入时进行了 DT。与脉冲发生器更换相比，新植入物更有可能进行 DT（71%比 32%，P=0.0001），但与原发性和继发性预防指征相似（64%比 63%，P=NS）。在未进行 DT 的患者中，给出的原因包括：认为不必要（44%）；认为不安全，主要是由于持续性心房颤动（37%）；缺乏麻醉师（20%）；以及患者或医生的偏好（6%）。当进行 DT 时，在 65%的情况下，单次成功电击大于或等于设备输出最大值以下 10J。97%的患者满足 10J 的安全裕度，需要修改系统的占 2.3%。在进行 DT 的患者中，有 4.4%发生主要围手术期并发症，而未进行 DT 的患者中，有 6.6%发生（P=NS）。进行 DT 的患者 ICD 植入费用增加了 844 美元（P=0.16），这主要是由于脉冲发生器更换患者的费用增加（28017 美元比 24545 美元，P=0.02）。
三分之一的 ICD 植入术未进行 DT，通常是因为认为没有必要或存在相对禁忌症。
