title: Elevated defibrillation threshold despite programmable tilt, pulse width, or implant of subcutaneous coil: role of higher energy devices.
abstract: The value of defibrillation threshold testing (DFT) has been debated in recent years, especially with developments in the technology of manufactured defibrillators, most of which are capable of delivering high energies (35 Joules [J]) and have programmable features such as tilt percentage and pulse width duration that increase the efficiency of biphasic shocks. The following is an unusual case of elevated DFT despite all attempts of invasive and noninvasive approaches--it highlights the importance of performing DFT testing particularly when implantable cardioverter defibrillator is indicated for secondary prevention of sudden cardiac death and the need for devices capable of delivering higher energies >35 J.
authors.affiliation: Department of Electrophysiology/Cardiology, Regional Arrhythmia Center, Southern California Kaiser Permanente Medical Group, Los Angeles, California 90027, USA. maged.f.nageh@kp.org
authors.forename: Maged F
authors.initials: MF
authors.lastname: Nageh
mesh_terms: D047548:Defibrillators / Q000009:adverse effects*; D004556:Electric Injuries / Q000209:etiology* / Q000517:prevention & control*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004735:Energy Transfer; D006801:Humans; D008297:Male; D008875:Middle Aged; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*