Patient, Physician, and Procedural Factors Influencing the Use of Defibrillation Testing during Initial Implantable Cardioverter Defibrillator Insertion: Findings from the NCDRR
ANDREA M. RUSSO, M.D.,* YONGFEI WANG, M.S.,† SANA M. AL-KHATIB, M.D., M.H.S.,‡ JEPTHA P. CURTIS, M.D.,† and RACHEL LAMPERT, M.D.†
Background: Advances in implantable cardioverter defibrillator (ICD) technology have resulted in more
effective defibrillation, and the need for defibrillation threshold (DFT) testing has been questioned.
Methods: A total of 64,227 initial ICD implant procedures performed at 1,261 facilities (April to
December 2010) in the NCDR RegistryTM were selected to identify patterns of practice related to DFT
testing. Patient, physician, and procedural characteristics were compared. Independent association of
DFT testing with in-hospital adverse events or mortality was also examined.
Results: DFT testing was performed in 71% of patients. Patients who did not undergo testing were older;
more often had heart failure, lower left ventricular ejection fraction, atrial arrhythmias, and a primary
prevention indication; and were more likely to receive a cardiac resynchronization therapy device. In
addition, patients who did not undergo testing were less likely to be implanted in a metropolitan area and
more often implanted at a teaching hospital, in New England, in the Mid-Atlantic, or in the Pacific U.S .
In-hospital adverse events occurred in 2.56% of patients who underwent DFT testing compared to 3.58%
who did not (P < 0.001). Death or any complication remained more likely to occur in patients who did
not undergo testing (odds ratio and 95% confidence interval: 1.46 [1.33, 1.61], P < 0.001), after adjusting
for baseline and procedural differences.
Conclusions: DFT testing is not performed in many (29%) patients in clinical practice. Patients who
did not undergo testing were more likely to have adverse events and to be older with more comorbidities,
which could explain why DFT testing was avoided. Prospective randomized data are needed to determine
the impact of DFT testing on outcome. (PACE 2013; 00:1–10)
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