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Reassessing Risk Factors for High Defibrillation Threshold: The EF‐SAGA Risk Score and Implications for Device Testing
Author(s) -
SHIH MICHAEL J.,
KAKODKAR SIDDHARTH A.,
KAID YOUSEF,
HASSEL JONATHAN L.,
YARLAGADDA SANTI,
FOGG LOUIS F.,
MADIAS CHRISTOPHER,
KRISHNAN KOUSIK,
TROHMAN RICHARD G.
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12838
Subject(s) - medicine , defibrillation , risk assessment , computer security , computer science
Objectives To reevaluate risk factors for high defibrillation threshold (DFT) and propose a risk assessment tool. Background Controversy exists over routine DFT testing during implantable cardioverter defibrillator (ICD) placement. Methods We retrospectively analyzed 1,642 consecutive patients who received an ICD and underwent DFT testing. Results The incidence of high DFT requiring addition of a subcutaneous array was 2.3%. Five significant independent variables predictive of high DFT were identified, including younger age, male gender (hazard ratio 1.99), left ventricular (LV) dysfunction, secondary prevention (hazard ratio 2.33), and amiodarone use (hazard ratio 2.39). Each 10‐year increase in age was indicative of a 0.35‐times lower chance of high DFT. Each 10% increase of LV ejection fraction (EF) was indicative of a 0.52‐times lower chance of high DFT. These five variables form the EF‐SAGA risk score (LVEF < 20%, Secondary prevention ICD indication, Age < 60 years, male Gender, Amiodarone use). Cumulative risk of high DFT increased incrementally; patients with four or more variables had an 8.9% likelihood of high DFT. Importantly, primary prevention patients with LVEF > 20% had a negative predictive value for high DFT of 99.3%. Conclusion We identified five independent predictors of high DFT. We propose the EF‐SAGA risk score to help decision making. Primary prevention patients with an LVEF > 20% had an exceedingly low incidence of high DFT suggesting that testing could be avoided in these patients. Careful assessment of the risk‐benefit ratio of testing is important in high‐risk patients.