title: Value of pre-hospital discharge defibrillation testing in recipients of implanted cardioverter defibrillators.
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.
authors.affiliation: Division of Cardiology, Department of Medicine, Arrhythmia Service, Montefiore Medical Center, Bronx, NY 10467, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Delvecchio
authors.forename: Heather A
authors.initials: HA
authors.lastname: Trivedi
authors.forename: John D
authors.initials: JD
authors.lastname: Fisher
authors.forename: Soo G
authors.initials: SG
authors.lastname: Kim
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Ferrick
authors.forename: Jay N
authors.initials: JN
authors.lastname: Gross
authors.forename: Eugen C
authors.initials: EC
authors.lastname: Palma
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects; D006334:Heart Function Tests; D006801:Humans; D010351:Patient Discharge / Q000592:standards