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Does Defibrillation Threshold Testing Confer Benefit to ICD Recipients?

1 Apr, 15 | by Alistair Lindsay

Defibrillation threshold (DFT) testing to confirm an implantable cardioverter-defibrillator (ICD) could effectively terminate ventricular fibrillation is widely accepted as part of routine practice without much evidence of efficacy. However, advances in ICD technology and evidence of initial shock efficacy have called into question the importance of DFT testing. While testing rarely results in immediate complications, ICD shocks can have adverse long-term consequences and DFT requires sedation that adds costs and complexity to the procedure. Healey and colleagues explored the efficacy and safety of ICD implantation with and without DFT testing in the single blind, multicenter, randomized non-inferiority Shockless IMPLant Evaluation (SIMPLE) trial. ICD candidates (including secondary prevention and cardiac resynchronization recipients) were randomized to each arm (1247 without DFT and 1253 receiving standard therapy). more…

ICD detection intervals: long or short?

16 May, 13 | by Alistair Lindsay

Implantable cardioverter-defibrillators (ICDs) are now the standard of care in primary and secondary prevention of malignant arrhythmias, however with their increasing use it has been noted that ICD therapies – both appropriate and inappropriate – are associated with an increased risk of death and worsening of heart failure. The recent Multicenter Automatic Defibrillator Implantation Trial to Reduce Inappropriate Therapy (MADIT-RIT) found that for primary prevention, prolonging the arrhythmia detection interval or setting a high cut-off rate reduced inappropriate therapies. more…

Novel ICD programming reduces mortality

13 Feb, 13 | by Alistair Lindsay

The implantable cardioverter-defibrillator (ICD) has consistently demonstrated benefit in reducing sudden cardiac death in patients at high risk of ventricular arrhythmias, but inappropriate ICD activations are a common occurrence with potential adverse effects on patient well-being and increased costs for health services. Strategies to reduce the frequency of inappropriate device activation without reducing efficacy in life-threatening situations would therefore be highly beneficial. more…

Infective endocarditis caused by cardiac devices

5 May, 12 | by Alistair Lindsay

The number of electronic cardiac devices, including pacemakers and cardioverter-defibrillators, being implanted each year is increasing.  As a result, there has been a 210% increase in the incidence of device infection between 1993 and 2008 in the United States.  Cardiac device infective endocarditis (CDIE) is significant in that it is associated with a higher mortality rate than device infection without endocarditis. more…

Many US ICD implants not evidence based

6 Jan, 11 | by Alistair Lindsay

For patients with severe systolic heart failure, several randomised trials have shown the ability of implantable cardioverter-defibrillator (ICD) devices to prevent sudden cardiac death.  However, current US guidelines recommend against ICD insertion within 3 months of an initial heart-failure diagnosis, or within forty days of a myocardial infarction. more…

ICD implant risks highlight increasing sub-specialisation

17 May, 09 | by Alistair Lindsay

Should cardiologists who are not electrophysiologists be inserting implantable cardioverter-defibrillators (ICDs)? Curtis et al. performed a retrospective cohort study of patients who had an ICD fitted between January 2006 and June 2007. Patients were grouped according to whom had implanted their device: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. The main outcome measures examined were the proportion of patients meeting the criteria for a defibrillator with cardiac resynchronization therapy (CRT-D) who received that device, and the in-hospital procedural complication rates. more…

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