PMID- 17161062
OWN - NLM
STAT- MEDLINE
DCOM- 20070108
LR  - 20131121
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 152
IP  - 6
DP  - 2006 Dec
TI  - Effect of defibrillation testing on management during implantable 
      cardioverter-defibrillator implantation.
PG  - 1104-8
AB  - BACKGROUND: Verification of defibrillation efficacy by defibrillation threshold 
      (DFT) testing during implantable cardioverter-defibrillator implantation is the 
      current standard. Generally, defibrillation of ventricular fibrillation at 10 J 
      below the maximum output of a device is felt to establish an adequate safety 
      margin. Nonetheless, DFT testing adds to cost and carries some potential for 
      morbidity, whereas its impact on outcomes in the modern era of defibrillator 
      technology is unclear. We aimed to determine the frequency that DFT testing 
      resulted in a change at device implant and to identify clinical and 
      echocardiographic predictors of the need for DFT testing. METHODS: We reviewed 
      all implantable cardioverter-defibrillators that were implanted at the London 
      Health Sciences Centre (Ontario, Canada) from June 1999 to August 2003 and used 
      multivariate analysis to determine variables associated with DFT test failures 
      and elevated DFT values. When a defibrillation failure was not observed, a lowest 
      energy to defibrillate (LED) was recorded. RESULTS: Among 168 implants, DFT 
      testing was successful with a minimum 10-J safety margin in 152 (90%), whereas 
      the remaining 16 required changes at device implant. In a multivariate analysis, 
      use of amiodarone was independently associated with DFT failure (odds ratio, 4.6; 
      95% confidence interval, 1.2-17.0). Significantly higher mean DFT/LED values were 
      observed among patients on amiodarone (1.36 J; P = .0041). Those with nonischemic 
      cardiomyopathy had a higher mean DFT/LED compared with those with ischemic 
      cardiomyopathy (1.44 J; P = .028). CONCLUSIONS: Use of amiodarone is associated 
      with a 4-fold increase in risk of DFT failure and subsequent need for changes at 
      implant to achieve a safe threshold. Defibrillation threshold testing appears to 
      be most useful for patients taking amiodarone.
FAU - Leong-Sit, Peter
AU  - Leong-Sit P
AD  - Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
FAU - Gula, Lorne J
AU  - Gula LJ
FAU - Diamantouros, Pantelis
AU  - Diamantouros P
FAU - Krahn, Andrew D
AU  - Krahn AD
FAU - Skanes, Allan C
AU  - Skanes AC
FAU - Yee, Raymond
AU  - Yee R
FAU - Klein, George J
AU  - Klein GJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anti-Arrhythmia Agents)
RN  - N3RQ532IUT (Amiodarone)
SB  - IM
MH  - Amiodarone/therapeutic use
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - Arrhythmias, Cardiac/*prevention & control
MH  - Cardiomyopathy, Dilated/*surgery
MH  - *Defibrillators, Implantable/standards
MH  - Differential Threshold
MH  - *Electrophysiologic Techniques, Cardiac
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Ischemia/*surgery
MH  - Predictive Value of Tests
MH  - Retrospective Studies
EDAT- 2006/12/13 09:00
MHDA- 2007/01/09 09:00
CRDT- 2006/12/13 09:00
PHST- 2006/03/17 00:00 [received]
PHST- 2006/06/07 00:00 [accepted]
PHST- 2006/12/13 09:00 [pubmed]
PHST- 2007/01/09 09:00 [medline]
PHST- 2006/12/13 09:00 [entrez]
AID - S0002-8703(06)00621-1 [pii]
AID - 10.1016/j.ahj.2006.06.025 [doi]
PST - ppublish
SO  - Am Heart J. 2006 Dec;152(6):1104-8. doi: 10.1016/j.ahj.2006.06.025.