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(Circulation. 2001;103:2159.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Implantation of Cardioverter Defibrillators Without Induction of Ventricular Fibrillation

Charles D. Swerdlow, MD

From the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.

Correspondence to Charles D. Swerdlow, MD, 8635 W Third Street, Ste 1190W, Los Angeles, CA 90048. E-mail swerdlow{at}ucla.edu

Background—The upper limit of vulnerability (ULV) is the weakest shock at which ventricular fibrillation (VF) is not induced by a T-wave shock. This study tested the hypothesis that a vulnerability safety margin based on the ULV can be used as an implantable cardioverter-defibrillator implantation criterion.

Methods and Results—Implantable cardioverter-defibrillators were implanted in 80 patients if T-wave shocks did not induce VF and the baseline-rhythm R wave was 7 mV. The T-wave shock was 10 J in the first 45 patients (group A) and 15 J in the last 35 patients (group B). After inductionless implantations, the first VF shock was programmed to the T-wave shock plus 5 J. If T-wave shocks induced VF, the ULV was measured and the first shock was programmed to the ULV+5 J. Inductionless implantations were performed in 58 patients (72%), 28 in group A (62%) and 30 in group B (86%; P=0.04). If T-wave scanning had been done at 15 J in group A patients, inductionless implantations could have been performed in 84% of them. At 3 months, VF was induced twice during electrophysiological study in 75 patients (94%). All VFs were detected in 4.7 s and were terminated by the first shock. During follow-up, 197 of 198 appropriate first shocks for rapid ventricular tachycardia or VF (99%) were successful in patients who had inductionless implantations (95% confidence intervals, 97% to 100%).

Conclusion—Inductionless implantations can be performed in >80% of implantable cardioverter-defibrillator recipients using a vulnerability safety margin based on a T-wave scan at 15 J.

Key Words: defibrillation • defibrillators, implantable • shock

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