Europace Advance Access published online on May 16, 2007
Europace, doi:10.1093/europace/eum083
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Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey
1 Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, 16033 Lavagna, Italy; 2 Boston Scientific Italy, Milan, Italy; 3 Ospedale Cisanello, Pisa, Italy; 4 Casa di Cura Santa Maria, Bari, Italy; 5 Ospedale Consorziale Policlinico, Bari, Italy; 6 Istituto Clinico Humanitas, Rozzano (MI), Italy; 7 Casa di Cura Villa Pini d'Abruzzo, Chieti, Italy; 8 Ospedale Maggiore della Carità, Novara, Italy; 9 Azienda Ospedaliero-Universitaria, Fondazione IRCAB, Udine, Italy
Aims Despite an effective defibrillation testing (DT) is considered mandatory to be consistent with the rules of good clinical practice, some physicians are concerned about the risk of complications related to the induction test, and in real world clinical practice, several implant procedures are performed without any induction test. We conducted a systematic nation-wide retrospective survey in order to determine the DT rate and its complications.
Methods and results An ad hoc questionnaire was sent to all 343 Italian implanting centres and the data from the 229 (67%) centres that answered were analysed. During the year 2005, a total of 7857 patients underwent a first implantation of cardioverter defibrillator (ICD), 38% of which with cardiac resynchronization therapy (CRT). Of these, 2356 (30%) were implanted without any induction test. In 35 (15%) centres, the induction test was performed in <25% of the patients, whereas in 136 (59%) centres, it was performed in >75% of the patients. At multivariable analysis, performed in a subset of 1206 patients from 107 centres, CRT device (OR=1.82) and primary prevention (OR=1.47) were independent predictors of the decision to not perform DT. However, altogether, the clinical variables accounted only for 35% of the total variance, whereas the remaining 65% was probably unrelated to clinical factors. There was a total of 22 (0.4%) life-threatening complications as a consequence of the induction test: 4 deaths (0.07%), 8 cardiopulmonary arrests requiring resuscitation manoeuvres (0.15%), 6 cardiogenic shocks (0.11%), 3 strokes (0.05%), and 1 pulmonary embolism (0.02%).
Conclusion In real world practice, DT is not performed in a substantial number of patients, most of these in the absence of legitimate reasons. The clinical impact of DT vs. no DT remains unclear until the not negligible complication rate is compared against the long-term potential benefit.
Key Words: Defibrillation testing, Implantable cardioverter defibrillator, Ventricular fibrillation
* Corresponding author. Tel: +39 0185 329 567; fax: +39 0185 306 506. E-mail address: mbrignole{at}asl4.liguria.it
Manuscript submitted 25 January 2007. Accepted after revision 3 April 2007.
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  B. Lemke, T. Lawo, M. Zarse, A. Lubinski, U. Kreutzer, J. Mueller, A. Schuchert, S. Mitzenheim, D. Danilovic, T. Deneke, et al. Patient-tailored implantable cardioverter defibrillator testing using the upper limit of vulnerability: the TULIP protocol Europace, August 1, 2008; 10(8): 907 - 913. [Abstract] [Full Text] [PDF]
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