Key result
In current Italian clinical practice, 67% of centers never perform defibrillation testing during de-novo transvenous ICD implantations, whereas 66% perform it systematically during subcutaneous ICD implantations.
Why the study?
Defibrillation testing recommendations vary across clinical scenarios for transvenous and subcutaneous ICDs, prompting an analysis of current real-world testing practices during implantations.
Cross-Sectional (n=72)
Yes
This survey highlights that in Italian clinical practice, defibrillation testing is frequently omitted during both T-ICD and S-ICD implantations, sometimes contrary to guideline recommendations.
DT practices differ markedly by ICD type in Italy; leaves open optimal testing strategies pending outcome data.
BACKGROUND: Defibrillation testing (DT) can be omitted in patients undergoing transvenous implantable cardioverter-defibrillator (T-ICD) implantation, but it is still recommended for patients at risk for a high defibrillation threshold and for ICD generator changes. Moreover, DT is still recommended on implantation of subcutaneous ICD (S-ICD). The aim of the present survey was to analyze the current practice of DT during T-ICD and S-ICD implantations. METHODS: In March 2021, an ad hoc questionnaire on the current performance of DT and the standard practice adopted during testing was completed at 72 Italian centers implanting S-ICD and T-ICD. RESULTS: 48 (67%) operators reported never performing DT during de-novo T-ICD implantations, while no operators perform it systematically. The remaining respondents perform it for patients at risk for a high defibrillation threshold. DT is never performed at T-ICD generator change. At the time of de-novo S-ICD implantation, DT is never performed by 9 (13%) operators and performed systematically by 48 (66%). The remaining operators frequently omit DT in patients with more severe systolic dysfunction. DT is not performed at S-ICD generator change by 92% of operators. DT is conducted by delivering a first shock energy of 65 J by 60% of operators, while the remaining 40% test lower energy values. CONCLUSIONS: In current clinical practice, most operators omit DT at T-ICD implantation, even when still recommended in the guidelines. DT is also frequently omitted at S-ICD implantation, and a wide variability exists among operators in the procedures followed during DT.
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Migliore et al. (2022) conducted a cross-sectional in Implantable cardioverter-defibrillator (ICD) implantation (n=72). Defibrillation testing (DT) practice was evaluated on Proportion of centers performing defibrillation testing during de-novo T-ICD and S-ICD implantations. In current Italian clinical practice, 67% of centers never perform defibrillation testing during de-novo transvenous ICD implantations, whereas 66% perform it systematically during subcutaneous ICD implantations.
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