Value of pre-hospital discharge defibrillation testing in recipients of implanted cardioverter defibrillators

Alexander Delvecchio, Heather A. Trivedi, John D. Fisher, Soo G. Kim, Kevin J. Ferrick, Jay N. Gross, Eugen C. Palma

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Opinions vary regarding the need to perform defibrillation testing prior to hospital discharge in recipients of state-of-the-art cardioverter defibrillators (ICDs). Our protocol is to perform predischarge ICD testing 1 day after implant. This report includes 682 consecutive implants. Adverse observations at testing were grouped into (1) risk of defibrillation failure, (2) surgical complications, (3) sensing/pacing issues or narrow defibrillation margin warranting closer follow-up, or (4) findings correctable by device reprogramming. Among the 682 patients, 63% had single-chamber and 37% dual-chamber or biventricular ICDs. In 48 patients (7%) there were 69 concerns and/or interventions, with overlaps among the four categories, including one failure to defibrillate (0.15%), and six other patients at risk. Surgical complications included 11 hematomas (1.6%), and six lead dysfunctions. Closer follow-up was indicated in 19 patients (2.7%), for high pacing thresholds in seven, sensing issues in seven, and <10 J defibrillation margin in five. Device reprogramming was needed in 31 patients (4.5%), for tachycardia detection and therapy settings in 12, and for pacing/sensing functions in 22 patients. In eight patients ventricular fibrillation could not be induced. There was no morbidity or mortality due to testing. The state-of-the-art ICDs delivering biphasic shocks are remarkably reliable. The routine pre-hospital discharge defibrillation testing of such ICDs may be optional and left to the physicians' discretion.

Original languageEnglish (US)
Pages (from-to)S260-S262
JournalPACE - Pacing and Clinical Electrophysiology
Volume28
Issue numberSUPPL. 1
DOIs
StatePublished - Jan 1 2005

Keywords

  • Defibrillator
  • ICD complications
  • ICD testing
  • Implantable cardioverter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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