Key result
The 15-J upper limit of vulnerability test with 3 coupling intervals correctly identified high defibrillation threshold patients with 100% sensitivity and reduced ventricular fibrillation induction to 23% compared to 51% with the 10-J test.
Why the study?
Does the 15-J ULV test improve the prediction of high defibrillation threshold without inducing ventricular fibrillation compared to the 10-J ULV test in patients undergoing ICD implantation?
Cohort (n=96)
No
Does the 15-J ULV test improve the prediction of high defibrillation threshold without inducing ventricular fibrillation compared to the 10-J ULV test in patients undergoing ICD implantation?
Absolute Event Rate: 23% vs 51%
Absolute Risk Reduction: 28%
p-value: p=<0.0001
The 15-J ULV test with 3 coupling intervals accurately identifies patients with high defibrillation thresholds while significantly reducing the need for ventricular fibrillation induction during ICD implantation.
May support 15-J ULV testing to reduce VF induction at ICD implant; hypothesis-generating and needs prospective validation before practice change.
BACKGROUND: The upper limit of vulnerability (ULV) closely correlates with the defibrillation threshold (DFT). The aim of this study was to establish the optimal protocol for using the ULV test to predict high DFT (>20 J) without inducing ventricular fibrillation (VF). METHODS AND RESULTS: The 10-J and 15-J ULV test with 3 coupling intervals (-20, 0, and +20 ms to the peak of T-wave) and the DFT test were performed in 96 patients receiving implantable cardioverter defibrillator. ULV ≤ 10 J was confirmed in 47 (49%). ULV ≤ 15 J was confirmed in 70 (77%) of 91 patients (15-J ULV test could not be done in 5). The sensitivity and negative predictive value of both ULV >10 J and >15 J for predicting high DFT were 100%. The specificity and positive predictive value of ULV >15 J were higher than those for ULV >10 J (85% vs. 55%, 43% vs. 22%, respectively). The rate of VF inducibility for confirming ULV ≤ 15 J was lower than that for ULV ≤ 10 J (23% vs. 51%, P<0.0001). On analysis of single 15-J ULV test only at the peak of T-wave, VF was not induced in 79 of 91 patients, but 4 of these had high DFT. CONCLUSIONS: The 15-J ULV test with 3 coupling intervals could correctly identify high-DFT patients and reduce the necessity for VF induction at defibrillator implantation.
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Takami et al. (2013) conducted a cohort in Patients undergoing implantable cardioverter defibrillator (ICD) or CRTD implantation (n=96). 15-J Upper Limit of Vulnerability (ULV) test vs. 10-J ULV test was evaluated on Rate of ventricular fibrillation (VF) inducibility during ULV testing (p=<0.0001). The 15-J upper limit of vulnerability test with 3 coupling intervals correctly identified high defibrillation threshold patients with 100% sensitivity and reduced ventricular fibrillation induction to 23% compared to 51% with the 10-J test.
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