Patient-tailored implantable cardioverter defibrillator testing using the upper limit of vulnerability: the TULIP protocol.
OBJECTIVE
We evaluated the feasibility of the TULIP (Threshold test using Upper Limit during ImPlantation) protocol, which was designed to provide a confirmed, low defibrillation energy value during implantable cardioverter defibrillator (ICD) implantation with only two induced ventricular fibrillation (VF) episodes.


RESULTS
Ninety-eight patients (62 +/- 12 years, 86 male) from 13 clinical centres underwent an active can ICD implantation. A single coupling interval derived from electrocardiogram lead II during ventricular pacing was used for VF induction shocks at 13, 11, 9, and 6 J in a step-down manner until the upper limit of VF induction (ULVI) was determined. If ULVI >or=9 J, a defibrillation energy of ULVI + 4 J was tested. For ULVI <9 J, the defibrillation test energy was 9 J. In 79/98 patients (80.6%), two induced VF episodes were sufficient to obtain confirmed defibrillation energy of 11.1 +/- 3.3 J. The mean strength of the successful VF induction shock was 6.8 +/- 4.3 J, the coupling interval was 303 +/- 35 ms, and the number of delivered induction shocks until the first VF induction was 3.9 +/- 1.6.


CONCLUSIONS
TULIP is a safe and simple device testing procedure allowing the determination of confirmed, low defibrillation energy in most patients with two VF episodes induced at a single coupling interval.
Department of Cardiology and Angiology, Medical Clinic II, BG University Hospital, Bergmannsheil, Bochum, Germany. bernd.lemke@rub.de
Bernd
B
Lemke
Thomas
T
Lawo
Markus
M
Zarse
Andrzej
A
Lubinski
Ulrich
U
Kreutzer
Johannes
J
Mueller
Andreas
A
Schuchert
Sabine
S
Mitzenheim
Dejan
D
Danilovic
Thomas
T
Deneke
D000465:Algorithms; D017147:Defibrillators, Implantable; D004867:Equipment Design; D019544:Equipment Failure Analysis / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000534:rehabilitation*