Canadian Registry of ICD Implant Testing Procedures (CREDIT): Current Practice, Risks, and Costs of Intraoperative Defibrillation Testing Journal Articles uri icon

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abstract

  • Defibrillation Testing at ICD Implantation. 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 ≥ 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. (J Cardiovasc Electrophysiol, Vol. 21, pp. 177‐182, February 2010)

authors

  • Healey, Jeffrey Sean
  • DORIAN, PAUL
  • MITCHELL, L BRENT
  • TALAJIC, MARIO
  • PHILIPPON, FRANCOIS
  • SIMPSON, CHRIS
  • YEE, RAYMOND
  • MORILLO, CARLOS A
  • Lamy, Andre
  • BASTA, MAGDY
  • BIRNIE, DAVID H
  • WANG, XIAOYIN
  • NAIR, GIRISH M
  • CRYSTAL, EUGENE
  • KERR, CHARLES R
  • CONNOLLY, STUART J

publication date

  • February 2010