The values of defibrillation testing at implantable cardioverter defibrillator implantation: 'and then there were none'

Abstract

Purpose of review: Since its advent, implantable cardioverter defibrillator (ICD) intra-operative defibrillation testing (DFT) has been a standard practice to confirm its optimal configuration. However, due to advances in device and lead technology, which now facilitate successful device implantation, and due to growing number of ICD primary prevention patients, the need for DFT has recently been questioned. The purpose of this review is to summarize the pro and contra DFT arguments, according to benefits, risk and clinical relevance, trying to identify the candidates for whom DFT is really indicated.

Recent findings: There is an ongoing debate on the need for DFT at ICD implant due to significant DFT-related complications; recently, many electrophysiologists have chosen not to perform DFT in many cases. Recent literature findings document large differences of practice between different centres and countries. In particular, there has been major debate and concern over performing DFT in patients with heart failure, indicated for CRT-D implants (cardiac resynchronization therapy with defibrillator).

Summary: Due to the potential for serious complications during DFT and expanding primary prevention ICD candidates, we agree with the growing tendency not to routinely perform DFT at implant, as the risks may overweigh the benefits.