Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.
Rambam Medical Center, Haifa, Israel.
Heart Rhythm. 2014 May;11(5):814-21. doi: 10.1016/j.hrthm.2014.01.030. Epub 2014 Jan 30.
Defibrillation threshold (DFT) testing during placement of an implantable cardioverter-defibrillator (ICD) has been considered mandatory. Accumulating data suggest a more limited role for DFT.
The purpose of this study was to compare the outcome of ICD recipients who underwent DFT testing compared with those who did not.
In this prospective cohort analysis of patients who received an ICD between July 2010 and March 2013, we compared patients who underwent DFT testing and those who did not. Primary end-points were death and malignant ventricular arrhythmias. Secondary end-points included the composite end-points and inappropriate ICD discharges.
Of the 3596 patients in the registry, 614 patients (17%) underwent DFT testing during ICD placement vs 2982 (83%) who did not. Variables associated with ICD testing were implantation for secondary prevention (relative risk [RR] 1.87), prior ventricular arrhythmias (RR 1.81), use of antiarrhythmic medication (RR 1.59), and sinus rhythm (RR 2.05). Factors predisposing against testing were cardiac resynchronization therapy defibrillator implantation (RR 0.56) and concomitant diuretic use (RR 0.71). ICD testing was not associated with 1-year mortality (5.3% vs 5.1%, P = .74), delivery of appropriate shocks (8.6% vs 5.6%, P = .16), combined outcomes of ventricular arrhythmias and death (12.9% vs 11.3%, P = .45), or inappropriate ICD discharges (3.9% vs 2.1%, P = .2) compared to no DFT testing.
No significant differences in the incidence of mortality, malignant ventricular arrhythmias, or inappropriate ICD discharges were observed between patients who underwent DFT testing compared to those who did not. Our results may support avoiding DFT testing during ICD placement, but this requires confirmation by additional prospective studies.
在植入式心脏复律除颤器（ICD）放置期间进行除颤阈值（DFT）测试一直被认为是强制性的。积累的数据表明 DFT 的作用更为有限。
本研究旨在比较接受 DFT 测试的 ICD 接受者与未接受 DFT 测试的患者的结果。
在这项 2010 年 7 月至 2013 年 3 月期间接受 ICD 的患者前瞻性队列分析中，我们比较了接受 DFT 测试和未接受 DFT 测试的患者。主要终点是死亡和恶性室性心律失常。次要终点包括复合终点和不适当的 ICD 放电。
在登记处的 3596 名患者中，有 614 名患者（17%）在 ICD 放置期间接受了 DFT 测试，而 2982 名患者（83%）未接受 DFT 测试。与 ICD 测试相关的变量包括二级预防植入（相对风险 [RR] 1.87）、先前的室性心律失常（RR 1.81）、抗心律失常药物的使用（RR 1.59）和窦性节律（RR 2.05）。不利于测试的因素是心脏再同步治疗除颤器植入（RR 0.56）和同时使用利尿剂（RR 0.71）。与无 DFT 测试相比，DFT 测试与 1 年死亡率（5.3%比 5.1%，P=.74）、适当电击的发生（8.6%比 5.6%，P=.16）、室性心律失常和死亡的综合结局（12.9%比 11.3%，P=.45）或不适当的 ICD 放电（3.9%比 2.1%，P=.2）无关。
与未接受 DFT 测试的患者相比，接受 DFT 测试的患者的死亡率、恶性室性心律失常或不适当的 ICD 放电发生率无显著差异。我们的结果可能支持在 ICD 放置期间避免 DFT 测试，但这需要通过额外的前瞻性研究来证实。
