title: Pre-discharge defibrillation testing: Is it still justified?
abstract: BACKGROUND
  An implantable cardioverter-defibrillator (ICD) is routinely used to prevent sudden cardiac death. Since the introduction of that device into clinical practice, a defibrillation test (the so-called pre-discharge test [PDT]) has been an inseparable part of the ICD implantation procedure. Recently, the usefulness of PDT has been called into question.
  
  
  METHODS
  The aim of this research was to analyze ICD tests performed within two time periods: in years 1995-2001 (period I) and 2007-2010 (period II), in order to compare the results of tests and solutions to all the problems with ICD systems revealed by means of PDT.
  
  
  RESULTS
  During period I, 193 tests were performed, among which the ICD system malfunction was observed in 16 cases. Those included: sensing issues, specifically R-wave undersensing during ventricular fibrillation (VF) (7 patients) and T-wave oversensing (4 patients), as well as high defibrillation threshold (DFT) (2 patients) and ICD-pacemaker interaction (3 patients). During period II, among 561 tests, system malfunction was observed in 15 cases. In 1 patient it was VF undersensing, and in the remaining 14 it was high DFT. All the above problems were solved by means of appropriate ICD reprogramming, repositioning of the endocardial defibrillation lead or implantation of an additional subcutaneous defibrillation lead.
  
  
  CONCLUSIONS
  Contemporary ICD technical solutions, compared to older systems, in most cases allow to avoid sensing problems. The key rationale behind ICD testing is the ability to confirm the efficacy of high-voltage therapy. Despite the increasing maximal defibrillation out-put of devices, and all possible adjustments to the characteristics of the impulse, there is still a group of patients that require additional procedures to ensure the appropriate defibrillation efficacy.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kempa
authors.forename: Tomasz
authors.initials: T
authors.lastname: Królak
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Drelich
authors.forename: Szymon
authors.initials: S
authors.lastname: Budrejko
authors.forename: Ludmiła
authors.initials: L
authors.lastname: Daniłowicz-Szymanowicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Lewicka
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kozłowski
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Raczak
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies
keywords: ICD; PDT; implantable cardioverter-defibrillator; pre-discharge test