Clinical evaluation of the safety of repetitive intraoperative defibrillation threshold testing.

R. Frame, R. Brodman, S. Furman, Soo G. Kim, J. Roth, Kevin J. Ferrick, I. Hollinger, Jay N. Gross, John Devens Fisher

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

One goal of the initial implantation procedure for a cardioverter defibrillator is determination of the configuration and patch location with the lowest defibrillation threshold (DFT). To determine the safety of multiple defibrillation tests, an analysis of the intraoperative defibrillation threshold tests (DFTT) in our patients was performed. In 84 patients, the mean number of DFT trials was 5.27; the mean number of joules received was 275.0. The maximum number of shocks in one implant procedure was 50 for a total of 4,895 joules without complications. Four patients received 30 or more DFT shocks without complication. There were two complications related directly to the DFTT: one patient with severe noninflammatory cardiomyopathy developed electromechanical dissociation and was subsequently resuscitated and survived; the second patient with severe triple vessel coronary artery disease suffered an intraoperative myocardial infarction during testing and eventually died 22 days postoperatively. All patients received an ICD unit; six patients had DFTs of greater than 20 joules. Based on our experience, we followed the clinical status (heart rate, blood pressure, ECG changes, fluid status, total anesthesia time) during the DFTT to determine the extent and duration of our testing protocol. Multiple shocks due to repositioning of the leads in a stable patient should not prohibit extensive testing as adverse consequences do not appear to be cumulative.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume15
Issue number6
StatePublished - Jun 1992

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Safety
Shock
Defibrillators
Cardiomyopathies
Coronary Artery Disease
Electrocardiography
Anesthesia
Heart Rate
Myocardial Infarction
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical evaluation of the safety of repetitive intraoperative defibrillation threshold testing. / Frame, R.; Brodman, R.; Furman, S.; Kim, Soo G.; Roth, J.; Ferrick, Kevin J.; Hollinger, I.; Gross, Jay N.; Fisher, John Devens.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 15, No. 6, 06.1992, p. 870-877.

Research output: Contribution to journalArticle

Frame, R. ; Brodman, R. ; Furman, S. ; Kim, Soo G. ; Roth, J. ; Ferrick, Kevin J. ; Hollinger, I. ; Gross, Jay N. ; Fisher, John Devens. / Clinical evaluation of the safety of repetitive intraoperative defibrillation threshold testing. In: PACE - Pacing and Clinical Electrophysiology. 1992 ; Vol. 15, No. 6. pp. 870-877.
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