Key result
Review proposes shared decision-making for DFT testing during right-sided ICD implants.
Why the study?
Large trials have shown omitting defibrillation threshold testing does not impact outcomes, but these excluded patients with right-sided ICD implants who may have higher DFTs.
Should defibrillation threshold (DFT) testing be performed during right-sided ICD implant procedures?
Should defibrillation threshold (DFT) testing be performed during right-sided ICD implant procedures?
This review highlights the lack of definitive evidence for omitting DFT testing in right-sided ICD implants and proposes a shared decision-making approach.
Answers are grounded in this paper and cite their sources.
Supports shared decision-making for DFT testing in right-sided ICD implants; leaves open the optimal strategy without randomized data.
Prevention of sudden death using ICDs requires the reliable delivery of a high-energy shock to successfully terminate VF. Until more recently, the device implant procedure included conducting defibrillation threshold (DFT) testing involving VF induction and shock delivery to ensure efficacy. Large clinical trials, including SIMPLE and NORDIC ICD, have subsequently demonstrated that this is unnecessary, with a practice of omitting DFT testing having no impact on subsequent clinical outcomes. However, these studies specifically excluded patients requiring devices implanted on the right side, in whom the shock vector is significantly different and smaller studies suggest a higher DFT. In this review, the data regarding the use of DFT testing, focusing on right-sided implants, and the results of a survey of current UK practice are presented. In addition, a strategy of shared decision-making when it comes to deciding on the use of DFT testing during right-sided ICD implant procedures is proposed.
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Pope et al. (2023) conducted a review in Right-sided ICD implants. Defibrillation threshold (DFT) testing was evaluated. A review of data and UK practice proposes a shared decision-making strategy for utilizing defibrillation threshold testing during right-sided ICD implant procedures.
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