Defibrillation Threshold Testing for Right-sided Device Implants: A Review to Inform Shared Decision-making, in Association with the British Heart Rhythm Society

Michael Tb Pope; John R Paisey; Paul R Roberts

doi:10.15420/aer.2022.38

Defibrillation Threshold Testing for Right-sided Device Implants: A Review to Inform Shared Decision-making, in Association with the British Heart Rhythm Society

Arrhythm Electrophysiol Rev. 2023 Apr 14:12:e10. doi: 10.15420/aer.2022.38. eCollection 2023.

Authors

Michael Tb Pope¹, John R Paisey², Paul R Roberts²

Affiliations

¹ Department of Cardiology, Royal Bournemouth Hospital, Bournemouth, UK.
² Department of Cardiology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.

Abstract

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.

Keywords: ICD; defibrillation threshold testing; right sided; shared decision-making.

Publication types

Review