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The relationship between defibrillation threshold and total mortality.

MedStar author(s):

1383-875X

Name of journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacingAbstract: BACKGROUND: The relationship between the defibrillation threshold (DFT) and total mortality is unclear.CONCLUSIONS: A high-implant DFT predicts an adverse prognosis, even when an adequate ICD safety margin is present.METHODS: A university hospital prospectively maintained implantable defibrillator (ICD) database identified 508 patients who underwent ICD implantation and had DFT testing performed at implant. Patients were placed in one of three groups based on the implant DFT (high (>20 J), moderate (19-11 J), or low DFT (<10 J)).RESULTS: Sixty-seven patients had a high DFT, 216 had a moderate DFT, and 225 had a low DFT. The mean left ventricular ejection fraction (LVEF) was 0.25, 0.28, and 0.30 in the high, moderate, and low DFT groups, respectively, (p=0.04). There were significantly more patients with a subcutaneous electrode in the high DFT group (p<0.001), more patients taking amiodarone (p<0.001), and more patients on oral anticoagulation (p=0.04). There were a total of 140 deaths during the follow-up period (mean 3.2+1.7 years). There were 24 deaths in the high DFT group (35.8%), 62 in the moderate DFT group (28.7%), and 54 in the low DFT group (24.0%) (p=0.05). Implant DFT was a significant predictor of mortality (p=0.01), as was age, LVEF (p<0.001), CAD (p=0.01), amiodarone use (p=0.02), and hematoma at implant (p=0.01). An elevated DFT was an independent predictor of mortality after controlling for all significant univariate variables (p=0.004).All authors: Kim MH, Morady F, Rubenstein JC, Strickberger SAFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1007/s10840-013-9831-5

Date added to catalog: 2014-08-21

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	24146190	Available		24146190

BACKGROUND: The relationship between the defibrillation threshold (DFT) and total mortality is unclear.

CONCLUSIONS: A high-implant DFT predicts an adverse prognosis, even when an adequate ICD safety margin is present.

METHODS: A university hospital prospectively maintained implantable defibrillator (ICD) database identified 508 patients who underwent ICD implantation and had DFT testing performed at implant. Patients were placed in one of three groups based on the implant DFT (high (>20 J), moderate (19-11 J), or low DFT (<10 J)).

RESULTS: Sixty-seven patients had a high DFT, 216 had a moderate DFT, and 225 had a low DFT. The mean left ventricular ejection fraction (LVEF) was 0.25, 0.28, and 0.30 in the high, moderate, and low DFT groups, respectively, (p=0.04). There were significantly more patients with a subcutaneous electrode in the high DFT group (p<0.001), more patients taking amiodarone (p<0.001), and more patients on oral anticoagulation (p=0.04). There were a total of 140 deaths during the follow-up period (mean 3.2+1.7 years). There were 24 deaths in the high DFT group (35.8%), 62 in the moderate DFT group (28.7%), and 54 in the low DFT group (24.0%) (p=0.05). Implant DFT was a significant predictor of mortality (p=0.01), as was age, LVEF (p<0.001), CAD (p=0.01), amiodarone use (p=0.02), and hematoma at implant (p=0.01). An elevated DFT was an independent predictor of mortality after controlling for all significant univariate variables (p=0.004).

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