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Canadian Registry of ICD Implant Testing Procedures (CREDIT): Current Practice, Risks, and Costs of Intraoperative Defibrillation Testing
Author(s) -
HEALEY JEFF S.,
DORIAN PAUL,
MITCHELL L. BRENT,
TALAJIC MARIO,
PHILIPPON FRANCOIS,
SIMPSON CHRIS,
YEE RAYMOND,
MORILLO CARLOS A.,
LAMY ANDRE,
BASTA MAGDY,
BIRNIE DAVID H.,
WANG XIAOYIN,
NAIR GIRISH M.,
CRYSTAL EUGENE,
KERR CHARLES R.,
CONNOLLY STUART J.
Publication year - 2010
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2009.01616.x
Subject(s) - medicine , contraindication , defibrillation , implantable cardioverter defibrillator , perioperative , implant , atrial fibrillation , intracardiac injection , implantable loop recorder , cardiology , emergency medicine , surgery , alternative medicine , pathology
Defibrillation Testing at ICD Implantation.Background: There is uncertainty about the proper role of defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion. Methods: A prospective registry was conducted at 13 sites in Canada between January 2006 and October 2007. Objectives: To document the details of DT, the reasons for not conducting DT, and the costs and complications associated with DT. Results: DT was conducted at implantation in 230 of 361 patients (64%). DT was more likely to be conducted for new implants compared with impulse generator replacements (71% vs 32%, P = 0.0001), but was similar for primary and secondary prevention indications (64% vs 63%, P = NS). Among patients not having DT, the reason(s) given were: considered unnecessary (44%); considered unsafe, mainly due to persistent atrial fibrillation (37%); lack of an anesthetist (20%); and, patient or physician preference (6%). When performed, DT consisted of a single successful shock ≥ 10J below maximum device output in 65% of cases. A 10J safety‐margin was met by 97% of patients, requiring system modification in 2.3%. Major perioperative complications occurred in 4.4% of patients having DT versus 6.6% of patients not having DT (P = NS). ICD insertion was $844 more expensive for patients having DT (P = 0.16), largely due to increased costs ($28,017 vs $24,545) among patients having impulse generator replacement (P = 0.02). Conclusions: DT was not performed in a third of ICD implants, usually due to a perceived lack of need or relative contraindication. (J Cardiovasc Electrophysiol, Vol. 21, pp. 177‐182, February 2010)