Predictors of high defibrillation threshold in the modern era

Edward F. Lin, Darshan Dalal, Alan Cheng, Joseph E. Marine, Saman Nazarian, Sunil Sinha, David D. Spragg, Harikrishna Tandri, Henry Halperin, Hugh Calkins, Ronald D. Berger, Gordon F. Tomaselli, Charles Henrikson

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    Abstract

    Introduction High defibrillation threshold (DFT) is a clinical problem in 1-8% of implantable cardioverter-defibrillator implants. Some clinicians and investigators question whether the benefits of routine DFT testing outweigh the risks. Identification of the predictors of elevated DFT may allow selective application of DFT testing. However, the clinical characteristics of patients with high DFT in the modern era have not been well-defined. Methods All patients who underwent DFT testing in our institution during an 8-year period were reviewed for this retrospective study. High DFT was defined as less than a 10-J safety margin on initial testing. For each case, the two cases preceding and two cases following by the same implanter were selected as controls. Results Of the 2,138 patients who underwent DFT testing, 48 (2.2%) met criteria for high DFT. Compared to 192 control patients, patients with high DFT were more likely to be younger (P = 0.004), have nonischemic cardiomyopathy (P = 0.036), have a longer QRS interval (P = 0.026), and have a left ventricular ejection fraction (LVEF) ≤ 0.25 (P = 0.013). On multivariate analysis, only younger age (P = 0.016) and LVEF ≤ 0.25 (P = 0.010) remained statistically significant predictors of elevated DFT. Conclusions High DFT was identified in 2.2% of ICD implants in our institution in recent years. Although younger age and depressed LVEF predicts this problem, elevated DFT occurred in patients of all ages and ejection fractions. Elimination of routine DFT testing appears to be premature given the prevalence and unpredictability of elevated DFT.

    Original languageEnglish (US)
    Pages (from-to)231-237
    Number of pages7
    JournalPACE - Pacing and Clinical Electrophysiology
    Volume36
    Issue number2
    DOIs
    StatePublished - Feb 2013

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    Stroke Volume
    Implantable Defibrillators
    Cardiomyopathies
    Multivariate Analysis
    Retrospective Studies
    Research Personnel
    Safety

    Keywords

    • high defibrillation threshold
    • implantable cardioverter-defibrillator
    • threshold testing

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Predictors of high defibrillation threshold in the modern era. / Lin, Edward F.; Dalal, Darshan; Cheng, Alan; Marine, Joseph E.; Nazarian, Saman; Sinha, Sunil; Spragg, David D.; Tandri, Harikrishna; Halperin, Henry; Calkins, Hugh; Berger, Ronald D.; Tomaselli, Gordon F.; Henrikson, Charles.

    In: PACE - Pacing and Clinical Electrophysiology, Vol. 36, No. 2, 02.2013, p. 231-237.

    Research output: Contribution to journalArticle

    Lin, EF, Dalal, D, Cheng, A, Marine, JE, Nazarian, S, Sinha, S, Spragg, DD, Tandri, H, Halperin, H, Calkins, H, Berger, RD, Tomaselli, GF & Henrikson, C 2013, 'Predictors of high defibrillation threshold in the modern era', PACE - Pacing and Clinical Electrophysiology, vol. 36, no. 2, pp. 231-237. https://doi.org/10.1111/pace.12039
    Lin, Edward F. ; Dalal, Darshan ; Cheng, Alan ; Marine, Joseph E. ; Nazarian, Saman ; Sinha, Sunil ; Spragg, David D. ; Tandri, Harikrishna ; Halperin, Henry ; Calkins, Hugh ; Berger, Ronald D. ; Tomaselli, Gordon F. ; Henrikson, Charles. / Predictors of high defibrillation threshold in the modern era. In: PACE - Pacing and Clinical Electrophysiology. 2013 ; Vol. 36, No. 2. pp. 231-237.
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    abstract = "Introduction High defibrillation threshold (DFT) is a clinical problem in 1-8{\%} of implantable cardioverter-defibrillator implants. Some clinicians and investigators question whether the benefits of routine DFT testing outweigh the risks. Identification of the predictors of elevated DFT may allow selective application of DFT testing. However, the clinical characteristics of patients with high DFT in the modern era have not been well-defined. Methods All patients who underwent DFT testing in our institution during an 8-year period were reviewed for this retrospective study. High DFT was defined as less than a 10-J safety margin on initial testing. For each case, the two cases preceding and two cases following by the same implanter were selected as controls. Results Of the 2,138 patients who underwent DFT testing, 48 (2.2{\%}) met criteria for high DFT. Compared to 192 control patients, patients with high DFT were more likely to be younger (P = 0.004), have nonischemic cardiomyopathy (P = 0.036), have a longer QRS interval (P = 0.026), and have a left ventricular ejection fraction (LVEF) ≤ 0.25 (P = 0.013). On multivariate analysis, only younger age (P = 0.016) and LVEF ≤ 0.25 (P = 0.010) remained statistically significant predictors of elevated DFT. Conclusions High DFT was identified in 2.2{\%} of ICD implants in our institution in recent years. Although younger age and depressed LVEF predicts this problem, elevated DFT occurred in patients of all ages and ejection fractions. Elimination of routine DFT testing appears to be premature given the prevalence and unpredictability of elevated DFT.",
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    author = "Lin, {Edward F.} and Darshan Dalal and Alan Cheng and Marine, {Joseph E.} and Saman Nazarian and Sunil Sinha and Spragg, {David D.} and Harikrishna Tandri and Henry Halperin and Hugh Calkins and Berger, {Ronald D.} and Tomaselli, {Gordon F.} and Charles Henrikson",
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    T1 - Predictors of high defibrillation threshold in the modern era

    AU - Lin, Edward F.

    AU - Dalal, Darshan

    AU - Cheng, Alan

    AU - Marine, Joseph E.

    AU - Nazarian, Saman

    AU - Sinha, Sunil

    AU - Spragg, David D.

    AU - Tandri, Harikrishna

    AU - Halperin, Henry

    AU - Calkins, Hugh

    AU - Berger, Ronald D.

    AU - Tomaselli, Gordon F.

    AU - Henrikson, Charles

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    N2 - Introduction High defibrillation threshold (DFT) is a clinical problem in 1-8% of implantable cardioverter-defibrillator implants. Some clinicians and investigators question whether the benefits of routine DFT testing outweigh the risks. Identification of the predictors of elevated DFT may allow selective application of DFT testing. However, the clinical characteristics of patients with high DFT in the modern era have not been well-defined. Methods All patients who underwent DFT testing in our institution during an 8-year period were reviewed for this retrospective study. High DFT was defined as less than a 10-J safety margin on initial testing. For each case, the two cases preceding and two cases following by the same implanter were selected as controls. Results Of the 2,138 patients who underwent DFT testing, 48 (2.2%) met criteria for high DFT. Compared to 192 control patients, patients with high DFT were more likely to be younger (P = 0.004), have nonischemic cardiomyopathy (P = 0.036), have a longer QRS interval (P = 0.026), and have a left ventricular ejection fraction (LVEF) ≤ 0.25 (P = 0.013). On multivariate analysis, only younger age (P = 0.016) and LVEF ≤ 0.25 (P = 0.010) remained statistically significant predictors of elevated DFT. Conclusions High DFT was identified in 2.2% of ICD implants in our institution in recent years. Although younger age and depressed LVEF predicts this problem, elevated DFT occurred in patients of all ages and ejection fractions. Elimination of routine DFT testing appears to be premature given the prevalence and unpredictability of elevated DFT.

    AB - Introduction High defibrillation threshold (DFT) is a clinical problem in 1-8% of implantable cardioverter-defibrillator implants. Some clinicians and investigators question whether the benefits of routine DFT testing outweigh the risks. Identification of the predictors of elevated DFT may allow selective application of DFT testing. However, the clinical characteristics of patients with high DFT in the modern era have not been well-defined. Methods All patients who underwent DFT testing in our institution during an 8-year period were reviewed for this retrospective study. High DFT was defined as less than a 10-J safety margin on initial testing. For each case, the two cases preceding and two cases following by the same implanter were selected as controls. Results Of the 2,138 patients who underwent DFT testing, 48 (2.2%) met criteria for high DFT. Compared to 192 control patients, patients with high DFT were more likely to be younger (P = 0.004), have nonischemic cardiomyopathy (P = 0.036), have a longer QRS interval (P = 0.026), and have a left ventricular ejection fraction (LVEF) ≤ 0.25 (P = 0.013). On multivariate analysis, only younger age (P = 0.016) and LVEF ≤ 0.25 (P = 0.010) remained statistically significant predictors of elevated DFT. Conclusions High DFT was identified in 2.2% of ICD implants in our institution in recent years. Although younger age and depressed LVEF predicts this problem, elevated DFT occurred in patients of all ages and ejection fractions. Elimination of routine DFT testing appears to be premature given the prevalence and unpredictability of elevated DFT.

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    KW - threshold testing

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