Faculty Collaboration Database

Clinical evaluation of the safety of repetitive intraoperative defibrillation threshold testing. Pacing Clin Electrophysiol 1992 Jun;15(6):870-7

Date

06/01/1992

Pubmed ID

1376899

DOI

10.1111/j.1540-8159.1992.tb03077.x

Scopus ID

2-s2.0-0026871028 (requires institutional sign-in at Scopus site)   52 Citations

Abstract

One goal of the initial implantation procedure for a cardioverter defibrillator is determination of the configuration and patch location with the lowest defibrillation threshold (DFT). To determine the safety of multiple defibrillation tests, an analysis of the intraoperative defibrillation threshold tests (DFTT) in our patients was performed. In 84 patients, the mean number of DFT trials was 5.27; the mean number of joules received was 275.0. The maximum number of shocks in one implant procedure was 50 for a total of 4,895 joules without complications. Four patients received 30 or more DFT shocks without complication. There were two complications related directly to the DFTT: one patient with severe noninflammatory cardiomyopathy developed electromechanical dissociation and was subsequently resuscitated and survived; the second patient with severe triple vessel coronary artery disease suffered an intraoperative myocardial infarction during testing and eventually died 22 days postoperatively. All patients received an ICD unit; six patients had DFTs of greater than 20 joules. Based on our experience, we followed the clinical status (heart rate, blood pressure, ECG changes, fluid status, total anesthesia time) during the DFTT to determine the extent and duration of our testing protocol. Multiple shocks due to repositioning of the leads in a stable patient should not prohibit extensive testing as adverse consequences do not appear to be cumulative.

Author List

Frame R, Brodman R, Furman S, Kim SG, Roth J, Ferrick K, Hollinger I, Gross J, Fisher JD

Author

James A. Roth MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Electric Countershock
Electrodes, Implanted
Female
Humans
Intraoperative Care
Male
Middle Aged
Monitoring, Intraoperative
Prostheses and Implants
Safety
Ventricular Fibrillation