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Pol. Merkur. Lek (Pol. Med. J.), 2014, XXIX/171: 153-156 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2014, XXIX/171: 153-156

Title: Comparison of treatment effectiveness of implantable cardioverter defibrillator in patients undergoing defibrillation threshold testing at the time of implantation versus no defibrillation threshold testing 

Authors: Lelakowski J., Tomala I., Rydlewska A., Majewski J., Kuniewicz M., Małecka B.

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Comparison of treatment effectiveness of implantable cardioverter defibrillator in patients undergoing defibrillation threshold testing at the time of implantation versus no defibrillation threshold testing


Lelakowski J., Tomala I., Rydlewska A., Majewski J., Kuniewicz M., Małecka B.

Jagiellonian University of Kraków, Collegium Medicum, Institute of Cardiology, Department of Electrocardiology, John Paul II Hospital in Cracow, Poland

Inability to perform defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation due to comorbidities may influence longterm survival.
Material and methods
. Retrospective review (2005–2007) identified 142 patients undergoing ICD implantation without DFT testing (No-DFT group). A control group consisting of 290 patients undergoing standard DFT testing (DFT group) was compared to the first group in terms of appropriate shocks, clinical shock efficacy and allcause mortality. The primary and secondary prophylactic therapy were performed to the estimation.
Results
. DFT testing was withheld due to atrial fibrillation with inability to exclude left atrial thrombus, left ventricular thrombus, congestive heart disease and(or) ischemia, hypotension and absent of anesthesiologist. The No-DFTgroup had a similar appropriate shock rate, but lower total survival (79.1% vs. 91.2%, p = 0.01) than the DFT group. In secondary prophylactic therapy, the No-DFT group had a higher incidence of sudden death (7.6% vs. 4.3%, p = 0.03) compared to the DFT group.
Conclusions
. The overall mortality was higher in the No-DFT group and number of sudden death in secondary prophylactic therapy. DFT testing should therefore remain the standard of care. Nevertheless, ICD therapy should not be withheld in patients who meet appropriate implant criteria simply on the basis of clinical scenarios that preclude routine DFT testing.

Key words: implantable cardioverter-defibrillator, defibrillation threshold testing

Pol. Merk. Lek., 2010, XXIX, 171, 153