Key result
Defibrillation threshold testing at the time of ICD implantation did not reduce total mortality (RR 0.94; 95% CI 0.74-1.21; P=0.65) or ventricular arrhythmias compared to no testing.
Why the study?
Does defibrillation threshold (DFT) testing reduce total mortality or ventricular arrhythmias in patients undergoing ICD implantation?
Meta-Analysis (n=5,020)
Yes
Does defibrillation threshold (DFT) testing reduce total mortality or ventricular arrhythmias in patients undergoing ICD implantation?
Relative Risk: 0.94 (95% CI 0.74–1.21)
p-value: p=0.65
Routine defibrillation threshold testing at the time of ICD implantation does not appear to improve long-term clinical outcomes such as mortality or ventricular arrhythmias.
Routine DFT testing may be omitted at ICD implantation; confirms no mortality or arrhythmia benefit across trials.
BACKGROUND: Defibrillation threshold (DFT) testing at the time of implantable cardioverter defibrillator (ICD) implantation is widely used in clinical practice, but reliable data supporting its routine use are lacking. We undertook a meta-analysis to evaluate the efficacy of DFT testing compared to no DFT testing at the time of ICD implantation. METHODS: We searched the MEDLINE and EMBASE databases for studies evaluating the effect of DFT testing on total mortality and ventricular arrhythmias during follow-up. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using random effects modeling. RESULTS: Eight studies involving 5,020 patients (3,068 undergoing DFT and 1,952 not undergoing DFT) were included. Of those, only one study was randomized. Reasons for not performing DFT included patient characteristics (four studies), center's standard practice (three studies), or randomization (one study). Median follow-up was 24 months. Overall, the quality of the included studies was rather poor. On the basis of the pooled estimate across the studies, DFT testing did not reduce total mortality or ventricular arrhythmias at follow-up (RR = 0.94, 95% CI 0.74-1.21; P = 0.65 and RR = 1.19, 95% CI 0.85-1.68; P = 0.30, respectively). No individual study had a major impact on the estimated RR or the statistical significance based on a sensitivity analysis. CONCLUSION: Recognizing the limited quality of current studies in the area of DFT testing and outcomes, available data suggest that DFT testing at the time of ICD implantation does not appear to predict total mortality and ventricular arrhythmias during follow-up. Large randomized controlled trials, adequately powered to detect clinical outcomes, are warranted.
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Stavrakis et al. (2013) conducted a meta-analysis in Implantable cardioverter defibrillator (ICD) implantation (n=5,020). Defibrillation threshold (DFT) testing vs. No DFT testing was evaluated on Total mortality (RR 0.94, 95% CI 0.74-1.21, p=0.65). Defibrillation threshold testing at the time of ICD implantation did not reduce total mortality (RR 0.94; 95% CI 0.74-1.21; P=0.65) or ventricular arrhythmias compared to no testing.
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