title: ICD implantation without intraoperative testing does not increase the rate of system modifications and does not impair defibrillation efficacy tested in follow-up.
abstract: OBJECTIVE
  The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions.
  
  
  METHODS
  In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks.
  
  
  RESULTS
  Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %.
  
  
  CONCLUSIONS
  Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.
authors.affiliation: Division of Cardiology and Electrophysiology, Medizinische Klinik 8, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471, Nuremberg, Germany. dirk.bastian@klinikum-nuernberg.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Bastian
authors.forename: Stefan
authors.initials: S
authors.lastname: Kracker
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.forename: Konrad
authors.initials: K
authors.lastname: Göhl
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000401:mortality* / Q000706:statistics & numerical data; D004556:Electric Injuries / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000401:mortality*; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome