open access

Vol 23, No 5 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-07-04
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Pre-discharge defibrillation testing: Is it still justified?

Maciej Kempa, Tomasz Królak, Łukasz Drelich, Szymon Budrejko, Ludmiła Daniłowicz-Szymanowicz, Ewa Lewicka, Dariusz Kozłowski, Grzegorz Raczak
DOI: 10.5603/CJ.a2016.0045
·
Pubmed: 27387062
·
Cardiol J 2016;23(5):532-538.

open access

Vol 23, No 5 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-07-04

Abstract

Background: An implantable cardioverter-defibrillator (ICD) is routinely used to prevent sudden cardiac death. Since the introduction of that device into clinical practice, a defibrillation test (the so-called pre-discharge test [PDT]) has been an inseparable part of the ICD implantation procedure. Recently, the usefulness of PDT has been called into question.

Methods: The aim of this research was to analyze ICD tests performed within two time periods: in years 1995–2001 (period I) and 2007–2010 (period II), in order to compare the results of tests and solutions to all the problems with ICD systems revealed by means of PDT.

Results: During period I, 193 tests were performed, among which the ICD system malfunction was observed in 16 cases. Those included: sensing issues, specifically R-wave undersensing during ventricular fibrillation (VF) (7 patients) and T-wave oversensing (4 patients), as well as high defibrillation threshold (DFT) (2 patients) and ICD-pacemaker interaction (3 patients). During period II, among 561 tests, system malfunction was observed in 15 cases. In 1 patient it was VF undersensing, and in the remaining 14 it was high DFT. All the above problems were solved by means of appropriate ICD reprogramming, repositioning of the endocardial defibrillation lead or implantation of an additional subcutaneous defibrillation lead.

Conclusions: Contemporary ICD technical solutions, compared to older systems, in most cases allow to avoid sensing problems. The key rationale behind ICD testing is the ability to confirm the efficacy of high-voltage therapy. Despite the increasing maximal defibrillation out­put of devices, and all possible adjustments to the characteristics of the impulse, there is still a group of patients that require additional procedures to ensure the appropriate defibrillation efficacy.

Abstract

Background: An implantable cardioverter-defibrillator (ICD) is routinely used to prevent sudden cardiac death. Since the introduction of that device into clinical practice, a defibrillation test (the so-called pre-discharge test [PDT]) has been an inseparable part of the ICD implantation procedure. Recently, the usefulness of PDT has been called into question.

Methods: The aim of this research was to analyze ICD tests performed within two time periods: in years 1995–2001 (period I) and 2007–2010 (period II), in order to compare the results of tests and solutions to all the problems with ICD systems revealed by means of PDT.

Results: During period I, 193 tests were performed, among which the ICD system malfunction was observed in 16 cases. Those included: sensing issues, specifically R-wave undersensing during ventricular fibrillation (VF) (7 patients) and T-wave oversensing (4 patients), as well as high defibrillation threshold (DFT) (2 patients) and ICD-pacemaker interaction (3 patients). During period II, among 561 tests, system malfunction was observed in 15 cases. In 1 patient it was VF undersensing, and in the remaining 14 it was high DFT. All the above problems were solved by means of appropriate ICD reprogramming, repositioning of the endocardial defibrillation lead or implantation of an additional subcutaneous defibrillation lead.

Conclusions: Contemporary ICD technical solutions, compared to older systems, in most cases allow to avoid sensing problems. The key rationale behind ICD testing is the ability to confirm the efficacy of high-voltage therapy. Despite the increasing maximal defibrillation out­put of devices, and all possible adjustments to the characteristics of the impulse, there is still a group of patients that require additional procedures to ensure the appropriate defibrillation efficacy.

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Keywords

pre-discharge test, PDT, implantable cardioverter-defibrillator, ICD

About this article
Title

Pre-discharge defibrillation testing: Is it still justified?

Journal

Cardiology Journal

Issue

Vol 23, No 5 (2016)

Pages

532-538

Published online

2016-07-04

DOI

10.5603/CJ.a2016.0045

Pubmed

27387062

Bibliographic record

Cardiol J 2016;23(5):532-538.

Keywords

pre-discharge test
PDT
implantable cardioverter-defibrillator
ICD

Authors

Maciej Kempa
Tomasz Królak
Łukasz Drelich
Szymon Budrejko
Ludmiła Daniłowicz-Szymanowicz
Ewa Lewicka
Dariusz Kozłowski
Grzegorz Raczak

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