Intraoperative Defibrillation Testing Should Not Be Generally Abandoned for All ICD Procedures-A Multicenter Study on 4,572 Consecutive Patients.
BackgroundThe ongoing technical advances in development of new implantable cardioverter defibrillator (ICD) systems led some investigators to question the routine use of intraoperative defibrillation testing (DT). Therefore, we evaluated retrospectively in a multicenter study effectiveness, safety, and usefulness of intraoperative DT on unbiased large patient population.MethodsData from 4,572 consecutive patients undergoing any ICD intervention were retrospectively analyzed. Besides efficacy of DT, risk factors for DT failure were identified in a multiple logistic regression analysis.ResultsOverall 5,483 shock data from 4,532 patients were available. Not tested for medical reasons were 13.5%. DT-associated complications were not noted. Primary DT effectiveness was 95.8%, whereas 4.2% were ineffective. Optimization (51.6% increase of DT energy, 10.1% subcutaneous lead array (SQ array), 2% generator exchange, 4.8% lead reposition, 9.3% lead exchange, and 22.2% change of shock parameters) led to successful DT in 152 patients (96.2%). Subanalyses and logistic regression identified implantation of generator in any other position than left subpectoral, age, body mass index and left ventricular ejection fraction as independent predictors for primary DT failure.ConclusionThe number of patients, including those undergoing generator exchange, system upgrade, or system revision, with inappropriate intraoperative testshock is relatively high. The results of recent prospective clinical trials can be extrapolated only on first ICD implantations with high-energy generators. For patients undergoing subcutaneous ICD implantation, right-sided implantation, patients with channelopathies and hypertrophic cardiomyopathy, as well as for procedures on already implanted ICD systems, the intraoperative DT might still be recommended.
Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
Tibor
T
Ziegelhoeffer
Herz und Gefass-Klinik, Bad Neustadt/Saale, Bayern, Germany.
Alexander
A
Siebel
Departmentof XVII -Cardiovascular Surgery, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Rheinland-Pfalz, Germany.
Andreas
A
Markewitz
Department of Cardiac Surgery, Sana HerzchirurgischeKlinik Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany.
Nicolas
N
Doll
Department of Cardiology, St. MarienKrankenhaus, Siegen, Germany.
Volker
V
Bärsch
Department of Cardiology, KatholischesKlinikum Koblenz Montabaur, Koblenz, Rheinland-Pfalz, Germany.
Markus
M
Reinartz
Department of Cardiovascular Surgery, Universitatsklinikum Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany.
Brigitte
B
Oswald
Department of Cardiology, St. Marien Hospital, Bonn, Germany.
Dieter
D
Bimmel
Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
Alexander
A
Meyer
Department of Cardiac Surgery, Sana HerzchirurgischeKlinik Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany.
Timo
T
Weimar
Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
Thomas
T
Walther
Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
Heiko
H
Burger
D000368:Aged; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005858:Germany; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008422:Materials Testing; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome