Zusammenfassung
Die intraoperative ICD-Testung wird traditionell in vielen Kliniken durchgeführt und dient der Sicherstellung einer effektiven Wahrnehmung, Detektion und Defibrillation von Kammerflimmern. Angesichts der technischen Fortentwicklung der Defibrillatoren hinsichtlich einer schnelleren und hochenergetischen Schockabgabe ist die Indikation einer intraoperativen ICD-Testung heutzutage zweifelhaft. Diese Übersicht trägt Pro und Contra-Argumente der intraoperativen ICD-Testung zusammen. Zahlreiche Argumente sprechen gegen eine systematische Testung bei allen Patienten: Erwägungen aus experimentellen Studien, patientenspezifische und unspezifische Faktoren, wie Schweregrad der zugrunde liegenden Herzerkrankung, Ischämien oder Medikamente, genau so wie ICD-spezifische Faktoren wie Typ und Lokalisation der implantierten Elektroden bzw. Gehäuse. Nicht zuletzt spielt die Testmethode selbst eine große Rolle, da sie bei hoher a priori positiver Testwahrscheinlichkeit die statistische Unsicherheit von falsch negativen Testresultaten mit sich bringt. Daher sind prospektive randomisierte Studien nötig, um die traditionelle Praxis der intraoperativen ICD-Testung auf einer evidenzbasierten Grundlage verlassen zu können.
Abstract
Intraoperative ICD-testing is traditionally performed in many hospitals in order to ensure reliable sensing, detection, and defibrillation of induced ventricular fibrillation. The technical progress of defibrillators allows rapid detection and delivery of high energy shocks which defibrillates effectively in the vast majority all patients at implant. This review describes arguments pro and contra of systematic testing of the defibrillation threshold in all patients. Many reasons argue against testing in all patients: experimental considerations, patients’ specific and nonspecific factors, e.g., underlying severity of cardiac disease, ischemia, and medication, as well as factors specific to the ICD system, e.g., implanted type and location of electrodes and active cans. Finally, the testing method is very important, since it bears the risk of false negative test results because the a priori probability of a positive test result is >95%. Therefore, data from prospective randomized studies are necessary in order to abandon the tradition of ICD-testing on an evidence-based background.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Almquist AK, Montgomery JV, Haas TS et al (2005) Cardioverter-defibrillator implantation in high-risk patients with hypertrophic cardiomyopathy. Heart Rhythm 2:814–819
Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 20(352):225–237
Bianchi S, Ricci RP, Biscione F et al (2009) Primary prevention implantation of cardioverter defibrillator without defibrillation threshold testing: 2-year follow-up. Pacing Clin Electrophysiol 32:573–578
Birnie D, Tung S, Simpson C et al (2008) Complications associated with defibrillation threshold testing: the Canadian experience. Heart Rhythm 5:387–390
Blatt JA, Poole JE, Johnson GW et al (2008) No benefit from defibrillation threshold testing in the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). J Am Coll Cardiol 52:551–556
Brignole M, Raciti G, Bongiorni MG et al (2007) Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey. Europace 9:540–543
Davy JM, Fain ES, Dorian P et al (1987) The relationship between successful defibrillation and delivered energy in open-chest dogs: reappraisal of the defibrillation threshold” concept. Am Heart J 113:77–84
Gold MR, Higgins S, Klein R et al (2002) Efficacy and temporal stability of reduced safety margins for ventricular defibrillation: primary results from the Low Energy Safety Study (LESS). Circulation 105:2043–2048
Gradaus R, Bode-Schnurbus L, Weber M et al (2002) Effect of ventricular fibrillation duration on the defibrillation threshold in humans. Pacing Clin Electrophysiol 25:14–19
Healey JS, Dorian P, Mitchell LB et al (2010) Canadian Registry of ICD Implant Testing Procedures (CREDIT): Current practice, risks and costs of intraoperative defibrillation testing. J Cardiovasc Electrophysiol 21:177–182
Hohnloser SH, Dorian P, Roberts R et al (2006) Effect of amiodarone and sotalol on ventricular defibrillation threshold: the optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. Circulation 114:104–109
Khalighi K, Daly B, Leino EV et al (1997) Clinical predictors of transvenous defibrillation energy requirements. Am J Cardiol 79:150–153
Kolb C, Tzeis S, Zrenner B (2009) Defibrillation threshold testing: tradition or necessity? Pacing Clin Electrophysiol 32:570–572
Kuhlkamp V, Dornberger V, Khalighi K et al (1998) Effect of a single element subcutaneous array electrode added to a transvenous electrode configuration on the defibrillation field and the defibrillation threshold. Pacing Clin Electrophysiol 21:2596–2605
Lever NA, Newall EG, Larsen PD (2007) Differences in the characteristics of induced and spontaneous episodes of ventricular fibrillation. Europace 9:1054–1058
Mainigi SK, Cooper JM, Russo AM et al (2006) Elevated defibrillation thresholds in patients undergoing biventricular defibrillator implantation: incidence and predictors. Heart Rhythm 3:1010–1016
Makikallio TH, Huikuri HV, Myerburg RJ et al (2002) Differences in the activation patterns between sustained and self-terminating episodes of human ventricular fibrillation. Ann Med 34:130–135
Mitchell LB, Pineda EA, Titus JL et al (2002) Sudden death in patients with implantable cardioverter defibrillators: the importance of post-shock electromechanical dissociation. J Am Coll Cardiol 39:1323–1328
Moss AJ, Greenberg H, Case RB et al (2004) Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 110:3760–3765
Moss AJ, Zareba W, Hall WJ et al (n d) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883
Niemann JT, Rosborough JP, Youngquist S et al (2007) Is all ventricular fibrillation the same? A comparison of ischemically induced with electrically induced ventricular fibrillation in a porcine cardiac arrest and resuscitation model. Crit Care Med 35:1356–1361
Packer DL, Prutkin JM, Hellkamp AS et al (2009) Impact of implantable cardioverter-defibrillator, amiodarone and placebo on the mode of death in stable patients with heart failure: analysis from the sudden cardiac death in heart failure trial. Circulation 120:2170–2176
Pires LA, Hull ML, Nino CL et al (1999) Sudden death in recipients of transvenous implantable cardioverter defibrillator systems: terminal events, predictors and potential mechanisms. J Cardiovasc Electrophysiol 10:1049–1056
Pires LA, Johnson KM (2006) Intraoperative testing of the implantable cardioverter-defibrillator: how much is enough? J Cardiovasc Electrophysiol 17:140–145
Poole JE, Johnson GW, Hellkamp AS et al (2008) Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359:1009–1017
Russo AM, Sauer W, Gerstenfeld EP et al (2005) Defibrillation threshold testing: is it really necessary at the time of implantable cardioverter-defibrillator insertion? Heart Rhythm 2:456–461
Schoels W, Steinhaus D, Johnson WB et al (2007) Optimizing implantable cardioverter-defibrillator treatment of rapid ventricular tachycardia: antitachycardia pacing therapy during charging. Heart Rhythm 4:879–885
Schwartzman D, Concato J, Ren JF et al (1996) Factors associated with successful implantation of nonthoracotomy defibrillation lead systems. Am Heart J 131:1127–1136
Shukla HH, Flaker GC, Jayam V et al (2003) High defibrillation thresholds in transvenous biphasic implantable defibrillators: clinical predictors and prognostic implications. Pacing Clin Electrophysiol 26:44–48
Sweeney MO, Sherfesee L, Degroot PJ et al (2010) Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm 7:353–360
Swerdlow CD, Russo AM, Degroot PJ (2007) The dilemma of ICD implant testing. Pacing Clin Electrophysiol 30:675–700
Taneja T, Goldberger J, Johnson D et al (2000) Is all ventricular fibrillation the same? Influence of mode of induction on characteristics of ventricular fibrillation. J Cardiovasc Electrophysiol 11:1355–1363
Viskin S, Rosso R (2008) The top 10 reasons to avoid defibrillation threshold testing during ICD implantation. Heart Rhythm 5:391–393
Wathen MS, Degroot PJ, Sweeney MO et al (2004) Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 110:2591–2596
Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortrags- und Seminarhonorare von Biotronik, Medtronic und Bard.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mewis, C., Neuberger, HR. & Buob, A. Ist die intraoperative ICD-Testung noch nötig?. Herzschr. Elektrophys. 21, 123–128 (2010). https://doi.org/10.1007/s00399-010-0080-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00399-010-0080-3