Key result
Low energy outputs successfully terminate VF when higher energies fail, permitting nonthoracotomy ICD implantation.
Why the study?
Standard step-down approaches using high energy outputs during defibrillation threshold testing may fail, necessitating alternative strategies for nonthoracotomy ICD implantation.
Can relatively low energy outputs successfully terminate ventricular fibrillation when high energy outputs fail during nonthoracotomy ICD implantation?
Case Report (n=1)
Can relatively low energy outputs successfully terminate ventricular fibrillation when high energy outputs fail during nonthoracotomy ICD implantation?
Testing lower energy outputs during ICD implantation may permit successful defibrillation and avoid thoracotomy when standard high-energy outputs fail.
May enable nonthoracotomy ICD implantation after high-energy failure; leaves open need for prospective validation.
At intraoperative testing of defibrillation thresholds during implantation of internal cardioverter defibrillators, standard step-down approaches of energy outputs are used. If relatively high energy outputs are not successful at defibrillating the heart, the electrodes are frequently reconfigured. When attempting implantation of a nonthoracotomy lead system, high defibrillation thresholds may warrant opening of the chest cavity to place one or more epicardial electrodes. A case is presented where a nonthoracotomy system was able to be implanted using relatively low energy outputs which were reproducibly successful at terminating ventricular fibrillation when higher energy outputs were unsuccessful. Mechanisms for this phenomenon and alternate recommendations for defibrillation testing are presented.
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Winters et al. (1996) conducted a case report in Ventricular fibrillation requiring internal cardioverter defibrillator (n=1). Relatively low energy outputs vs. High energy outputs was evaluated on Successful termination of ventricular fibrillation. Relatively low energy outputs successfully terminated ventricular fibrillation and permitted implantation of a nonthoracotomy defibrillator system when higher energy outputs were ineffective.
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