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Comment
. 2023 Jul 4;25(7):euad184.
doi: 10.1093/europace/euad184.

Successful defibrillation testing in patients undergoing elective subcutaneous implantable cardioverter-defibrillator generator replacement

Jolien A de Veld  1 , Shari Pepplinkhuizen  1 , Willeke van der Stuijt  1 , Anne-Floor B E Quast  1 , Louise R A Olde Nordkamp  1 , Kirsten M Kooiman  1 , Arthur A M Wilde  1 , Lonneke Smeding  1 , Reinoud E Knops  1
Affiliations
Comment

Successful defibrillation testing in patients undergoing elective subcutaneous implantable cardioverter-defibrillator generator replacement

Jolien A de Veld et al. Europace. .

Abstract

Aims: After implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD), a defibrillation test (DFT) is performed to ensure that the device can effectively detect and terminate the induced ventricular arrhythmia. Data on DFT efficacy at generator replacement are scarce with a limited number of patients and conflicting results. This study evaluates conversion efficacy during DFT at elective S-ICD generator replacement in a large cohort from our tertiary centre.

Methods and results: Retrospective data of patients who underwent an S-ICD generator replacement for battery depletion with subsequent DFT between February 2015 and June 2022 were collected. Defibrillation test data were collected from both implant and replacement procedures. PRAETORIAN scores at implant were calculated. Defibrillation test was defined unsuccessful when two conversions at 65 J failed. A total of 121 patients were included. The defibrillation test was successful in 95% after the first and 98% after two consecutive tests. This was comparable with success rates at implant, despite a significant rise in shock impedance (73 ± 23 vs. 83 ± 24 Ω, P < 0.001). Both patients with an unsuccessful DFT at 65 J successfully converted with 80 J.

Conclusion: This study shows a high DFT conversion rate at elective S-ICD generator replacement, which is comparable to conversion rates at implant, despite a rise in shock impedance. Evaluating device position before generator replacement may be recommended to optimize defibrillation success at generator replacement.

Keywords: Defibrillation test; Generator replacement; Impedance; PRAETORIAN score; Subcutaneous ICD.

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Conflict of interest statement

Conflict of interest: R.E.K. reports consultancy fees and research grants from Abbott, Boston Scientific, Cardiac, and Medtronic and has stock options from AtaCor Medical Inc. A.A.M.W. is a member of the Scientific advisory board of Thryv Therapeutics and ARMGO. K.M.K. reports consultancy fees from Boston Scientific. The other authors report no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Defibrillation test success after generator replacement. When including an 80 J shock, all patients had a successful conversion. Patients with a successful shock at 65 J or less were considered to be successful at 80 J as well. DFT, defibrillation test.
See this image and copyright information in PMC

Comment on

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