[Is DFT testing still mandatory?].
The automatic detection and termination of ventricular fibrillation is still the key function of implantable cardioverter defibrillator (ICD) therapy. The progress in generator and lead technology has overcome limitations in defibrillation efficacy in early transvenous defibrillator devices. Current, active pectoral biphasic devices provide a high defibrillation efficacy. More than 90% of all patients will meet accepted implantation criteria without any intraoperative system modifications. Is this enough to abandon the intraoperative assessment of defibrillation efficacy? Arguments for abandoning intraoperative device testing include: reduction of perioperative complications, time and cost saving, no worse prognosis for defibrillator patients with borderline defibrillation efficacy, DFT testing might be a barrier to an easy access to ICD implantation. Abandoning intraoperative assessment of defibrillation efficacy may result in inadequate defibrillation safety in up to 9% of all patients. The noninferior outcome of patients with nonadequate defibrillation efficacy is not already proven. Intraoperative device testing could be limited to a small number of VF inductions, the safety of these protocols is well established. A significant time and cost reduction is not really existing. The abandoning of defibrillation testing will not lead to an increase in ICD implant capacity. The intraoperative assessment of defibrillation efficacy should be an important part of ICD implantation.
Neuzner
Jörg
J
Medizinische Klinik II, Klinikum Kassel. neuzner@klinikum-kassel.de
D002986:Clinical Trials as Topic; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation* / Q000379:methods*; D019544:Equipment Failure Analysis / Q000379:methods* / Q000592:standards; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019919:Prosthesis Implantation / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards