Key result
Elevated defibrillation thresholds occur in 2.2%–12% of specific populations and are associated with higher mortality, suggesting a potential role for tuned-duration defibrillation waveforms.
Why the study?
Current ICD technology can deliver 35-40 J, questioning routine DFT testing, yet elevated DFTs occur in 2.2%-12% of tested subjects and correlate with higher mortality.
Does modifying from fixed-tilt to tuned-duration defibrillation waveform improve defibrillation success in patients with high defibrillation thresholds?
Does modifying from fixed-tilt to tuned-duration defibrillation waveform improve defibrillation success in patients with high defibrillation thresholds?
Modifying ICD waveform from fixed-tilt to tuned-duration may achieve successful defibrillation in cases where standard settings fail.
May warrant tuned waveforms in high-DFT cases; leaves open randomized mortality confirmation.
Implantable cardioverter-defibrillator (ICD) therapy has become more efficient owing to changes in waveform morphology and output. Current ICD technology is capable of delivering 35–40 J, raising the question of the value of routine defibrillation threshold (DFT) testing. However, when DFT testing is done in specific populations, elevated DFTs have been reported in 2.2%–12% of subjects.1 Furthermore, Siddiqi and colleagues2 reported that patients with high DFTs have a higher mortality than those with acceptable DFT.
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Hayashi et al. (2022) conducted an editorial in Elevated defibrillation threshold. Tuned-duration defibrillation waveform vs. Fixed-tilt defibrillation waveform was evaluated. Elevated defibrillation thresholds occur in 2.2%–12% of specific populations and are associated with higher mortality, suggesting a potential role for tuned-duration defibrillation waveforms.
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