title: Clinical predictors of transvenous defibrillation energy requirements.
abstract: Nonthoracotomy and, more recently, transvenous lead systems have become routine for initial implantable cardioverter-defibrillator (ICD) placement. Previous studies of clinical predictors of nonthoracotomy defibrillation energy requirements evaluated multiple complex lead systems that included subcutaneous patches. However, the predictors of an adequate transvenous defibrillation threshold (DFT) have not been assessed previously. Accordingly, the present study is a prospective evaluation of DFT using a uniform testing protocol in 119 consecutive patients undergoing ICD implantation with a single transvenous lead. For each patient, 38 parameters were assessed including standard clinical, echocardiographic, and radiographic measures. An adequate monophasic DFT (< or =20 J) was achieved in 76% of patients. Multivariable analysis revealed 3 independent factors predictive of a high threshold: preoperative amiodarone use (odds ratio = 5.8, p < or =0.002), echocardiographic measures of left ventricular dilation (odds ratio = 0.47, p < or =0.005) and body size (odds ratio = 0.51, p < or =0.006). Patients receiving amiodarone who also had left ventricular dilation constitute a group at considerable (69%) risk for having a high DFT. In contrast, patients with neither of these risk factors have only an 11% chance of having a high threshold. We conclude that an adequate transvenous DFT can be predicted from simple clinical parameters.
authors.affiliation: The Department of Medicine, University of Maryland Medical System, Baltimore 21201, USA.
authors.forename: K
authors.initials: K
authors.lastname: Khalighi
authors.forename: B
authors.initials: B
authors.lastname: Daly
authors.forename: E V
authors.initials: EV
authors.lastname: Leino
authors.forename: S R
authors.initials: SR
authors.lastname: Shorofsky
authors.forename: N G
authors.initials: NG
authors.lastname: Kavesh
authors.forename: R W
authors.initials: RW
authors.lastname: Peters
authors.forename: M R
authors.initials: MR
authors.lastname: Gold
mesh_terms: D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001824:Body Constitution; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004554:Electric Countershock / Q000379:methods*; D004567:Electrodes, Implanted; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D005544:Forecasting; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone