Document Detail

Defibrillation energy requirements in an ICD population receiving cardiac resynchronization therapy.
MedLine Citation:
PMID:  16643394     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: While defibrillation energy requirements (DERs) have been extensively studied in patients receiving conventional defibrillators, the DERs of patients receiving cardiac resynchronization therapy with defibrillation capability (CRT-D) devices have not been well described. The purpose of this analysis was to characterize DERs (defined as true threshold or the presence of appropriate safety margins) in patients undergoing implant of a CRT-D and to determine whether DERs in this population were similar to those reported for patients undergoing implantation of conventional defibrillators. METHODS: Data were analyzed retrospectively from the VENTAK CHF/CONTAK CD biventricular pacing study. An appropriate safety margin of at least 10 J was verified with at least two successful conversions with 21 J or less. Multivariate logistic regression was performed to determine baseline predictors of failed DER testing. RESULTS: Of 501 patients enrolled, 444 (89%) had successful DER test outcomes. Of the remaining 57 patients, 34 converted with energies > or = 21J, and 23 had their testing terminated prematurely or were not tested, primarily due to patient condition. Larger left ventricular internal dimension in diastole (P = 0.003) and prolonged procedure time (P = 0.01) were significant predictors of higher energy requirements. Few significant complications arose from DER testing. CONCLUSIONS: DER testing can be accomplished safely and successfully in the majority of CRT-D patients. However, safety margins cannot be ascertained in a significant number of these patients. Left ventricular inner diameter in diastole (LVIDd) and prolonged procedure time may predict higher DERs, and could be used to anticipate the need for a high-energy device or inclusion of a subcutaneous array.
Claudio Schuger; Kenneth A Ellenbogen; Mitchell Faddis; Bradley P Knight; Patrick Yong; Ross Sample;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-04-28     Completed Date:  2006-06-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  247-50     Citation Subset:  IM    
Henry Ford Hospital, Detroit, Michigan, USA.
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MeSH Terms
Arrhythmias, Cardiac / therapy*
Defibrillators, Implantable*
Electric Countershock
Logistic Models
Middle Aged
Prospective Studies
ROC Curve
Retrospective Studies
Treatment Outcome

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

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