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Single tests of implantable cardioverter defibrillators can be performed in selected patients at a low risk of neuronal damage
Author(s) -
Gestrich Christopher,
Mellert Fritz,
Schaefer Magdalena,
Treede Hendrik,
Schrickel Jan Wilko,
Schacht Daniel,
Thudium Marcus
Publication year - 2021
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.14159
Subject(s) - medicine , implantable cardioverter defibrillator , cardiology , ventricular fibrillation , cerebral perfusion pressure , brain damage , cerebral blood flow
Background Defibrillator testing (DFT) is still used in selected patients to ensure adequate therapy. To do so, ventricular fibrillation is induced and terminated by the implanted cardioverter defibrillator (ICD). Studies have shown increases in neuronal damage markers without a measurable clinical effect in patients after defibrillator threshold testing with multiple shocks. Objective The aim of this study was to measure clinical outcomes, neuronal damage parameters (NSE and S100), and intraoperative cerebral perfusion (Doppler, near infra‐red spectroscopy [NIRS]) in patients undergoing single DFT after transvenous ICD implantation and comparing them to untested patients. Method We included 23 patients. Nine underwent surgery with a single DFT, 14 were not tested. Cognitive impairment was tested using the Mini‐Mental‐Status Test (MMST) and the DEMTECt 24 h prior and postsurgery. We also measured S100 and Neuron‐Specific Enolase (NSE) at these timepoints. During surgery we measured medial cerebral artery velocity and cerebral tissue oxygen saturation (rSO 2 ). Results We found no significant differences between the patient groups except for a significant increase in mean arterial blood pressure and an increase in rSO 2 after testing. One patient with cerebral vasculopathy had a significant increase in his NSE values without showing clinical symptoms. This patient also had low rSO 2 measurements and a decrease in medial cerebral artery velocity after DFT, other than the other patients. Conclusion Single DFT did not lead to signs of neuronal damage or cognitive impairment except in one case with pre‐existing cerebral vasculopathy. Therefore, our results support the use of DFT in carefully selected patients.