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Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing.

Publication ,  Journal Article
Hall, B; Jeevanantham, V; Levine, E; Daubert, J; McNitt, S; Hall, F; Hall, FMAFP; Morady, FMAFP; Pelosi, F
Published in: Cardiol J
2007

BACKGROUND: Inability to perform defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation due to co-morbidities may influence long-term survival. METHODS: Retrospective review at The University of Michigan (1999-2004) identified 55 patients undergoing ICD implantation without DFT testing ("No-DFT group"). A randomly selected sample of patients (n = 57) undergoing standard DFT testing ("DFT group") was compared in terms of appropriate shocks, clinical shock efficacy and all-cause mortality. RESULTS: DFT testing was withheld due to hypotension, atrial fibrillation with inability to exclude left atrial thrombus, left ventricular thrombus, CHF and/or ischemia. The No-DFT group had a similar appropriate shock rate, but lower total survival (69.1% vs. 91.2%, p = 0.004) than the DFT group. The No-DFT group had a higher incidence of ventricular fibrillation (VF) episodes (9.1% vs. 3.1%, p = 0.037), and deaths attributable to VF (3 of 17 deaths vs. 0 of 5 deaths) compared to the DFT group. Multivariate analysis found a trend toward increased risk of death in the No-DFT group (HR 3.18, 95% CI 0.82-12.41, p = 0.095) after adjusting for baseline differences in gender distribution, NYHA class and prior CABG. CONCLUSIONS: In summary, overall mortality was higher in the No-DFT group. More deaths attributable to VF occurred in the No-DFT group. Thus, DFT testing should therefore remain the standard of care. Nevertheless, ICD therapy should not be withheld in patients who meet appropriate implant criteria simply on the basis of clinical scenarios that preclude routine DFT testing. (Cardiol J 2007; 14: 463-469).

Duke Scholars

Published In

Cardiol J

EISSN

1898-018X

Publication Date

2007

Volume

14

Issue

5

Start / End Page

463 / 469

Location

Poland

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
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Hall, B., Jeevanantham, V., Levine, E., Daubert, J., McNitt, S., Hall, F., … Pelosi, F. (2007). Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing. Cardiol J, 14(5), 463–469.
Hall, Burr, Vinodh Jeevanantham, Ethan Levine, James Daubert, Scott McNitt, Freburr Hall, Fred Morady And Frank Pelosiburr Hall, Fred Morady And Frank Pelosid Morady, and Frank Pelosi. “Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing.Cardiol J 14, no. 5 (2007): 463–69.
Hall B, Jeevanantham V, Levine E, Daubert J, McNitt S, Hall F, Hall FMAFP, Morady FMAFP, Pelosi F. Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing. Cardiol J. 2007;14(5):463–469.

Published In

Cardiol J

EISSN

1898-018X

Publication Date

2007

Volume

14

Issue

5

Start / End Page

463 / 469

Location

Poland

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology