title: Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators.
abstract: BACKGROUND
  Implantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered.
  
  
  METHODS
  In a prospectively designed study all 870 patients (60.0 ± 14  years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27 ± 12%. Implantation site was right in 4.5% and left in 95.5%.
  
  
  RESULTS
  Five patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28 ± 8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures.
  
  
  CONCLUSIONS
  Implantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. andreas.keyser@klinik.uni-regensburg.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Keyser
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hilker
authors.forename: Ekrem
authors.initials: E
authors.lastname: Ucer
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wittmann
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D013318:Stroke Volume; D019616:Thoracic Surgical Procedures / Q000379:methods*