Predictors of high defibrillation threshold in patients with implantable cardioverter-defibillator using a transvenous dual-coil lead.
BACKGROUND
Defibrillation testing (DT) is considered a standard procedure during implantable cardioverter-defibrillator (ICD) implantation. However, little is known about the factors that are significantly related to patients with high defibrillation threshold (DFT) using the present triad system.


RESULTS
We examined 286 consecutive patients who underwent ICD implantation with a transvenous dual-coil lead and DT from December 2000 to December 2011. We defined patients who required 25 J or more by the implanted device as the high DFT group, and those who required less than 25 J as the normal DFT group. For each patient, assessment parameters included underlying disease, comorbidities, NYHA functional class, drugs, and echocardiographic measures. The high DFT group consisted of 12 patients (4.2%). Multivariate analysis identified 3 independent predictors for high DFT: atrial fibrillation (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.24-22.33, P=0.023), hypertension (OR 4.01, 95% CI 1.08-15.96, P=0.039), thickness of interventricular septum (IVS) >12 mm (OR 4.82, 95% CI 1.17-20.31, P=0.030).


CONCLUSIONS
Atrial fibrillation, hypertension and IVS hypertrophy were significantly associated with high DFT. Identification of such patients could help to lower the risk of complications with DT.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine.
Kazuya
K
Mizukami
Hisashi
H
Yokoshiki
Hirofumi
H
Mitsuyama
Masaya
M
Watanabe
Taro
T
Tenma
Yoshiro
Y
Matsui
Hiroyuki
H
Tsutsui
D001281:Atrial Fibrillation / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy; D006346:Heart Septum / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000517:prevention & control
D002317:Cardiovascular Agents