Omission of defibrillation testing did not significantly affect mortality or shock efficacy in most recipients of subcutaneous implantable cardioverter-defibrillators, a new study finds.
Among recipients of subcutaneous implantable cardioverter defibrillators, the omission of defibrillation testing was not associated with significant differences in mortality, or in the rates of appropriate and inappropriate shocks.
Obesity and high shock impedance, however, predicted testing failure.Current guidelines recommend DT during the implantation of a subcutaneous implantable cardioverter-defibrillator ; omissions of DT has yielded conflicting results regarding mortality and shock efficacy. Researchers analyzed data from an ongoing observational study, including 4924 patients who were implanted with S-ICD systems in France between October 2012 and December 2019. The analysis compared outcomes in patients who underwent DT and those who did not over a mean follow-up of 4.2 years. The outcomes included overall mortality, cardiovascular mortality, sudden cardiac death, a composite of sudden cardiac death or death of unknown origin, and appropriate and inappropriate shocks.The omission of DT was not associated with an increased risk for any of the outcomes, including all death-related endpoints, or inappropriate and appropriate shocks. DT was successful in 99% of patients; independent predictors of test failure were obesity , then the system implantation features should be reevaluated with attention to posterior and preferably intermuscular implantation of the generator and minimal distance between the shocking coil and the sternum. These measures are likely to reduce the HV impedance. If the value remains elevated, then perhaps, in this scenario, DT offers clinical value,” they added.This study was led by Fawzi Kerkouri, MD, MPH, of European Georges Pompidou Hospital in Paris, France. It was publishedClinicians may have omitted DT in patients with low risk or those with favorable procedural characteristics, introducing selection bias. Residual confounding may have persisted despite adjustments. Some cases of sudden cardiac death may have been misclassified as deaths of unknown origin.This study was funded by the French Federation of Cardiology and the French Society of Cardiology. The studied device was manufactured by Boston Scientific, which supported the annual meeting of the study investigators. Several authors reported serving as consultants and/or receiving fees from Boston Scientific. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Electrophysiology Shock Implantable Cardioverter Defibrillator Defibrillation And Cardioversion Automatic Internal Cardiac Defibrillator Implantable Cardioverter-Defibrillator Implantable Cardioverter Defibrillator (ICD) Defibrillator Cardiovascular Imaging Cardiac Imaging CV Imaging Obesity Obese Sudden Cardiac Death
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