Abstract 17851: Is Defibrillation Threshold Testing Needed for Right-Sided ICD Implants?
The need for defibrillation testing is controversial due to low defibrillation thresholds (DFT) with standard left pectoral implants and transvenous leads. Ongoing trials of DFT testing excluded right-sided implants because of concern of high DFTs. We performed a retrospective case-control analysis of DFT in consecutive patients undergoing dual coil, transvenous ICD implantation. All patients underwent a uniform, modified step-down DFT protocol, with an elevated DFT defined as > 25 J. There were 63 right-sided and 1067 left-sided implants. Patients receiving right- vs left-sided implants were similar with regards to age (62.8 ± 13.2 vs 63.8 ± 12.3, p = 0.59), gender (73.2% vs 71.4% male, p = 0.76), left ventricular ejection fraction (31 ± 12.7% vs 32 ± 12.2%, p = 0.68), and baseline medical therapy, including amiodarone (9.8% vs 11.1%, p = 0.72). Right-sided implants were significantly more likely to require hemodialysis (15.9% vs 1.5%, p <0.0001). Mean DFTs were about 2J higher with right-sided implants (p< 0.05) but there was no significant difference in the proportion of high DFTs (Table). An inadequate defibrillation safety margin is present in similar percentages of right- and left-sided implants. Therefore, decisions regarding the need for testing of right- and left-sided implants should be similar.
- © 2012 by American Heart Association, Inc.