Key result
An unusual case demonstrated elevated defibrillation threshold despite programmable tilt, pulse width, and subcutaneous coil implant, highlighting the need for devices capable of delivering >35 Joules.
Case Report (n=1)
This case highlights the ongoing importance of defibrillation threshold testing in secondary prevention ICD implants and the potential need for devices delivering >35 Joules.
May warrant high-output ICD consideration in refractory cases; leaves open optimal device energy and DFT testing protocols.
The value of defibrillation threshold testing (DFT) has been debated in recent years, especially with developments in the technology of manufactured defibrillators, most of which are capable of delivering high energies (35 Joules [J]) and have programmable features such as tilt percentage and pulse width duration that increase the efficiency of biphasic shocks. The following is an unusual case of elevated DFT despite all attempts of invasive and noninvasive approaches--it highlights the importance of performing DFT testing particularly when implantable cardioverter defibrillator is indicated for secondary prevention of sudden cardiac death and the need for devices capable of delivering higher energies >35 J.
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Maged F. Nageh (2011) conducted a case report in Elevated defibrillation threshold (n=1). Defibrillation threshold testing and higher energy devices (>35 J) was evaluated on Elevated defibrillation threshold despite invasive and noninvasive approaches. An unusual case demonstrated elevated defibrillation threshold despite programmable tilt, pulse width, and subcutaneous coil implant, highlighting the need for devices capable of delivering >35 Joules.
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