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. 2022 Jan 11:38:100952.
doi: 10.1016/j.ijcha.2022.100952. eCollection 2022 Feb.

The "Defibrillation Testing, Why Not?" survey. Testing of subcutaneous and transvenous defibrillators in the Italian clinical practice

Federico Migliore  1 , Stefano Viani  2 , Matteo Ziacchi  3 , Luca Ottaviano  4 , Pietro Francia  5 , Valter Bianchi  6 , Silvana De Bonis  7 , Paolo De Filippo  8 , Gianfranco Tola  9 , Alessandro Vicentini  10 , Erika Taravelli  11 , Valeria Ilia Calvi  12 , Mariolina Lovecchio  13 , Sergio Valsecchi  13 , Giovanni Luca Botto  14 ; “S-ICD Rhythm Detect” Investigators
Affiliations

The "Defibrillation Testing, Why Not?" survey. Testing of subcutaneous and transvenous defibrillators in the Italian clinical practice

Federico Migliore et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Defibrillation testing (DT) can be omitted in patients undergoing transvenous implantable cardioverter-defibrillator (T-ICD) implantation, but it is still recommended for patients at risk for a high defibrillation threshold and for ICD generator changes. Moreover, DT is still recommended on implantation of subcutaneous ICD (S-ICD). The aim of the present survey was to analyze the current practice of DT during T-ICD and S-ICD implantations.

Methods: In March 2021, an ad hoc questionnaire on the current performance of DT and the standard practice adopted during testing was completed at 72 Italian centers implanting S-ICD and T-ICD.

Results: 48 (67%) operators reported never performing DT during de-novo T-ICD implantations, while no operators perform it systematically. The remaining respondents perform it for patients at risk for a high defibrillation threshold. DT is never performed at T-ICD generator change. At the time of de-novo S-ICD implantation, DT is never performed by 9 (13%) operators and performed systematically by 48 (66%). The remaining operators frequently omit DT in patients with more severe systolic dysfunction. DT is not performed at S-ICD generator change by 92% of operators. DT is conducted by delivering a first shock energy of 65 J by 60% of operators, while the remaining 40% test lower energy values.

Conclusions: In current clinical practice, most operators omit DT at T-ICD implantation, even when still recommended in the guidelines. DT is also frequently omitted at S-ICD implantation, and a wide variability exists among operators in the procedures followed during DT.

Keywords: Defibrillation testing; Implantable defibrillator; Subcutaneous; Survey.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Defibrillation testing execution during de-novo T-ICD implantations (panel A) and reasons to perform defibrillation testing in selected cases (B).
Fig. 2
Fig. 2
Defibrillation testing execution during de-novo S-ICD implantations (panel A) and reasons to perform defibrillation testing in selected cases (B).
See this image and copyright information in PMC

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