Document Detail


Canadian Registry of ICD Implant Testing procedures (CREDIT): current practice, risks, and costs of intraoperative defibrillation testing.
MedLine Citation:
PMID:  19804544     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is uncertainty about the proper role of defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion. METHODS: A prospective registry was conducted at 13 sites in Canada between January 2006 and October 2007. OBJECTIVES: To document the details of DT, the reasons for not conducting DT, and the costs and complications associated with DT. RESULTS: DT was conducted at implantation in 230 of 361 patients (64%). DT was more likely to be conducted for new implants compared with impulse generator replacements (71% vs 32%, P = 0.0001), but was similar for primary and secondary prevention indications (64% vs 63%, P = NS). Among patients not having DT, the reason(s) given were: considered unnecessary (44%); considered unsafe, mainly due to persistent atrial fibrillation (37%); lack of an anesthetist (20%); and, patient or physician preference (6%). When performed, DT consisted of a single successful shock > or = 10J below maximum device output in 65% of cases. A 10J safety-margin was met by 97% of patients, requiring system modification in 2.3%. Major perioperative complications occurred in 4.4% of patients having DT versus 6.6% of patients not having DT (P = NS). ICD insertion was $844 more expensive for patients having DT (P = 0.16), largely due to increased costs ($28,017 vs $24,545) among patients having impulse generator replacement (P = 0.02). CONCLUSIONS: DT was not performed in a third of ICD implants, usually due to a perceived lack of need or relative contraindication.
Authors:
Jeff S Healey; Paul Dorian; L Brent Mitchell; Mario Talajic; Francois Philippon; Chris Simpson; Raymond Yee; Carlos A Morillo; Andre Lamy; Magdy Basta; David H Birnie; Xiaoyin Wang; Girish M Nair; Eugene Crystal; Charles R Kerr; Stuart J Connolly;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-05
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-82     Citation Subset:  IM    
Affiliation:
The Population Health Research Institute, McMaster University, Hamilton, Canada. healeyj@hhsc.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Canada / epidemiology
Defibrillators, Implantable / economics*,  statistics & numerical data
Equipment Failure Analysis / economics*,  statistics & numerical data
Health Care Costs / statistics & numerical data
Heart Failure / economics*,  epidemiology,  prevention & control*
Humans
Intraoperative Care / utilization*
Middle Aged
Physician's Practice Patterns / economics*,  statistics & numerical data
Prevalence
Registries / statistics & numerical data*
Risk Assessment
Risk Factors
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2010 Feb;21(2):183-5   [PMID:  19804540 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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