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January 1, 2003Pacing and Clinical Electrophysiology

Safety of a Single Successful Conversion of Ventricular Fibrillation Before the Implantation of Cardioverter Defibrillators

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Why the study?

Does a single successful 14 J shock provide equivalent safety for conversion of spontaneous ventricular tachyarrhythmias compared to systematic defibrillation threshold testing in patients undergoing initial ICD implantation?

Population

720 patients undergoing initial implantable cardioverter defibrillator implantation with a dual-coil…

Comparison

Single successful conversion of ventricular… vs Systematic defibrillation threshold testing.

Design

RCT, Fifty percent of all patients were randomized to full output shock energy.

Follow-up

mean 24 +/- 12 months

Authors

MGMichael R. GoldElectrophysiologyDBDavid BreiterUniversity of Maryland Medical SystemRLRobert B. LemanMedical University of South Carolina

Discussion

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Member takes

Overview

Supports a single successful 14 J shock as adequate endpoint in initial ICD implantation; confirms equivalent VF conversion success to systematic testing.

Structured PICO

Does a single successful 14 J shock provide equivalent safety for conversion of spontaneous ventricular tachyarrhythmias compared to systematic defibrillation threshold testing in patients undergoing initial ICD implantation?

P
Population
720 patients undergoing initial implantable cardioverter defibrillator (ICD) implantation with a dual-coil transvenous lead and active pulse generator.
I
Intervention
Single successful conversion of ventricular fibrillation by an initial 14 J shock during ICD implantation.
C
Comparator
Systematic defibrillation threshold testing (enhanced defibrillation threshold requiring at least 4 shocks).
O
Outcome
Conversion rates for spontaneous ventricular tachyarrhythmias at rates > 200 beats/min.safety

A single successful 14 J shock during ICD implantation appears to be a safe and sufficient endpoint, potentially eliminating the need for multiple shocks during defibrillation threshold testing.

Cite This Study

Gold et al. (2003) studied this question.

synapsesocial.com/papers/6a9d96cbef6cfb4b18fcf34ehttps://doi.org/10.1046/j.1460-9592.2003.00077.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.1985 · 452 citations
  2. 2The relationship between successful defibrillation and delivered energy in open-chest dogs: Reappraisal of the “defibrillation threshold” concept1987 · 217 citations
  3. 3Improved Survival with an Implanted Defibrillator in Patients with Coronary Disease at High Risk for Ventricular Arrhythmia1996 · 4,187 citations
  4. 4Efficacy and Temporal Stability of Reduced Safety Margins for Ventricular Defibrillation2002 · 136 citations
  5. 5Derivation of a Defibrillator Implant Criterion Based on Probability of Successful Defibrillation1997 · 25 citations