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The Saga of Defibrillation Testing: When Less Is More

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

In the current era of implantable cardioverter-defibrillator procedures, the decision of whether or not to perform defibrillation threshold testing at the time of implantation is now less of a clinical conundrum. In this paper, we summarize this current practice, beginning with the physiology of defibrillation, followed by a review of the salient data, and discussion of specific situations where defibrillation threshold testing remains a clinical consideration.

Recent Findings

Two prospective randomized trials demonstrated no mortality difference and no overall complication rate difference between patients who underwent defibrillation testing at implant compared with patients who underwent no defibrillation testing.

Summary

Current recommendations support eliminating routine defibrillation testing in left-sided transvenous implantable cardioverter-defibrillator primary prevention implants. Defibrillation testing remains indicated in subcutaneous defibrillator implants in the absence of contraindications.

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Abbreviations

CHD:

Congenital heart disease

CRT:

Cardiac resynchronization therapy

DFT:

Defibrillation threshold testing

DT:

Defibrillation testing

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricular ejection fraction

NCDR:

National Cardiovascular Data Registry

VF:

Ventricular fibrillation

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

The authors gratefully acknowledge the artistic assistance of Kory Zide in designing Figs. 1 and 2.

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Authors and Affiliations

  1. Washington University in St. Louis, St. Louis, MO, USA

    Marye J. Gleva

  2. University of Washington, 1959 NE Pacific Street, Box 356422, Seattle, WA, 98195, USA

    Melissa Robinson & Jeanne Poole

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  1. Marye J. Gleva
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  2. Melissa Robinson
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Correspondence to Jeanne Poole.

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Conflict of Interest

Marye J. Gleva reports that Washington University in St. Louis participated in some of the randomized trials of implantable cardioverter defibrillators that are included in the references.

Melissa Robinson reports personal fees from Medtronic, Abbott, and Boston Scientific.

Jeanne Poole reports personal fees from Medtronic, Kestra Inc., Boston Scientific, and Biotronik.

Marye J. Gleva reports personal fees from Abbott, BIOTRONIK, Boston Scientific, Kestra, Inc, Medtronic, and Zoll Medical

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Gleva, M.J., Robinson, M. & Poole, J. The Saga of Defibrillation Testing: When Less Is More. Curr Cardiol Rep 20, 44 (2018). https://doi.org/10.1007/s11886-018-0987-6

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