title: Defibrillation testing during implantable cardioverter-defibrillator implantation in Italian current practice: the Assessment of Long-term Induction clinical ValuE (ALIVE) project.
abstract: BACKGROUND
  Clinical practice with regard to defibrillation threshold (DFT) testing during implantable cardioverter-defibrillator (ICD) implantation varies considerably, even among experienced implanting centers. International guidelines do not as yet mandate DFT testing.
  
  
  OBJECTIVE
  The objective of this project is to assess current clinical decision making regarding DFT testing during ICD implantation.
  
  
  METHODS
  The ALIVE project collected data on DFT testing from a multicenter network of Italian clinicians sharing a common system for the collection, management, analysis, and reporting of clinical and diagnostic data from patients with Medtronic (Minneapolis, MN) implantable devices.
  
  
  RESULTS
  Data on 2,082 consecutive patients implanted with a Medtronic ICD in 111 Italian centers, over the period 2007 to 2010, were analyzed. Defibrillation threshold testing was performed in 33% of cases (678/2,082). The main reasons for performing the test were physician's clinical practice ("I always perform DFT") (80%) and secondary prevention implantation (12%). The main reasons for not performing DFT testing were centers' practice (44%), primary prevention (31%), and device replacement (15%). In 22 patients, ventricular fibrillation induction was not achieved; 656 patients completed DFT testing: 633 patients (96%) performed a single test, 19 patients (3%) performed a second induction test, and 4 patients (0.6%) underwent an additional induction test.
  
  
  CONCLUSIONS
  The preliminary results of the ALIVE project show that a great number of implant procedures are performed without DFT testing in the common practice of the participating centers. We also measured an inhomogeneous, center-dependent DFT testing behavior, which suggests the importance of defining a common guideline for ICD implant testing. Follow-up data on our patients will provide more information on the clinical value of the test.
authors.affiliation: Fatebenefratelli Hospital, Rome, Italy. stefbianchi@gmail.com
authors.forename: Bianchi
authors.initials: B
authors.lastname: Stefano
authors.forename: Ricci Renato
authors.initials: RR
authors.lastname: Pietro
authors.forename: Gasparini
authors.initials: G
authors.lastname: Maurizio
authors.forename: Lunati
authors.initials: L
authors.lastname: Maurizio
authors.forename: Marconi
authors.initials: M
authors.lastname: Renato
authors.forename: Landolina
authors.initials: L
authors.lastname: Maurizio
authors.forename: Rossi
authors.initials: R
authors.lastname: Pietro
authors.forename: Proclemer
authors.initials: P
authors.lastname: Alessandro
authors.forename: Botto
authors.initials: B
authors.lastname: Gianluca
authors.forename: Merico
authors.initials: M
authors.lastname: Monica
authors.forename: Canonaco
authors.initials: C
authors.lastname: Sergio
authors.forename: Santini
authors.initials: S
authors.lastname: Massimo
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome