Document Detail


Predischarge arrhythmia induction testing of implantable defibrillators may be unnecessary in selected cases.
MedLine Citation:
PMID:  9416936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Complete postoperative evaluation of implantable cardioverter-defibrillators (ICDs) before discharge, including arrhythmia induction, has been the standard since their introduction. Whereas the original ICDs provided little telemetered information and used separate pace-sense and defibrillation leads, modern, third-generation devices provide pace-sense function information in addition to other data and are used in conjunction with integrated transvenous endocardial leads that combine pace-sense and defibrillation function. Changes in lead position, which can potentially result in either an inability to detect fibrillation or to terminate it, should be mirrored by changes in resting pace-sense function. Thus, for newer ICDs implanted with integrated endocardial lead systems, it is possible that in at least some cases predischarge arrhythmia inductions can be avoided. Two hundred patients receiving third-generation ICDs in conjunction with integrated transvenous leads were evaluated before discharge. Defibrillation detection or termination problems were seen in 8. Declines in resting R-wave amplitude and pacing impedance were significantly associated with such complications (-7 +/- 5 vs -0.3 +/- 2.3 mV [p <0.0001] and -158 +/- 138 vs -93 +/- 76 omega [p <0.05], for those with vs without complications, respectively), as were gross right ventricular lead migrations on chest x-ray. No patient with a defibrillation complication had an R-wave change of <3 mV. However, 13% of patients without complications had R-wave changes of >3 mV. It is concluded that a pace-sense evaluation of ICDs may be a satisfactory screen to determine those who need to go on to complete testing with arrhythmia induction in selected cases.
Authors:
D N Weiss; P Zilo; R M Luceri; S Platt; M Rosenbaum
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  80     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-01-20     Completed Date:  1998-01-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1562-5     Citation Subset:  AIM; IM    
Affiliation:
Florida Arrhythmia Consultants, Fort Lauderdale, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arrhythmias, Cardiac / etiology*,  physiopathology,  therapy
Defibrillators, Implantable* / adverse effects
Electrocardiography
Humans
Male

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