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Are routine arrhythmia inductions necessary in patients with pectoral implantable cardioverter defibrillators?
M Glikson1, D Luria, P A Friedman
1Division of Cardiovascular and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. mglikson@post.tau.ac.il
Insights
Routine arrhythmia inductions after implantable cardioverter defibrillator (ICD) implantation may not be necessary for all patients. Ventricular fibrillation induction has low yield in low-risk patients, while ventricular tachycardia induction is less useful without prior inducibility or events.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- The utility of routine arrhythmia induction during follow-up for new-generation pectoral implantable cardioverter defibrillators (ICDs) remains unclear.
- Assessing the necessity of these procedures is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To evaluate the value of routine ventricular arrhythmia inductions in the follow-up of patients with pectoral ICDs.
- To determine the yield of ventricular fibrillation (VF) and ventricular tachycardia (VT) inductions at different time points post-implantation.
Main Methods:
- Retrospective analysis of a prospectively collected database of 153 patients with pectoral ICDs.
- Arrhythmia inductions (VF and VT) were performed at predismissal, 3 months, and 1 year post-implantation.
- Analysis of findings in relation to defibrillation threshold (DFT) and patient history.
Main Results:
- Routine predismissal VF induction identified important findings in 8.8% of patients, primarily those with high DFT or concomitant pacemakers.
- Subsequent VF inductions at 3 months and 1 year had a low yield (5.9% and 3.8%), mainly in patients with prior high DFT.
- VT induction led to programming changes in a significant portion of patients (37.4% at predismissal, decreasing to 13.8% at 1 year), particularly those with baseline inducible VT and clinical events.
Conclusions:
- Routine arrhythmia inductions may not be universally necessary within the first year post-ICD implantation.
- VF inductions offer limited value in patients with low DFTs and no pacemakers.
- VT inductions are less beneficial in patients without baseline inducible VT or clinical events.
- Further prospective studies and expert consensus are needed to guide patient selection for routine inductions.
Introduction:
The value of ventricular arrhythmia inductions as part of routine implantable cardioverter defibrillator (ICD) follow-up in new-generation pectoral ICDs is unknown.
Methods And Results:
We performed a retrospective analysis of a prospectively collected database analyzing data from 153 patients with pectoral ICDs who had routine arrhythmia inductions at predismissal, and 3 months and 1 year after implantation. Routine predismissal ventricular fibrillation (VF) induction yielded important findings in 8.8% of patients, all in patients with implantation defibrillation threshold (DFT) > or = 15 J or with concomitant pacemaker systems. At 3 months and 1 year, routine VF induction yielded important findings in 5.9% and 3.8% of tested patients, respectively, all in patients who had high DFT on prior testing. Ventricular tachycardia (VT) induction at predismissal, and 3 months and 1 year after implantation resulted in programming change in 37.4%, 28.1%, and 13.8% of tested patients, almost all in patients with inducible VT on baseline electrophysiologic study and clinical episodes since implantation.
Conclusion:
Although helpful in identifying potentially important ICD malfunctions, routine arrhythmia inductions during the first year after ICD implantation may not be necessary in all cases. VF inductions have a low yield in patients with previously low DFTs who lack concomitant pacemakers. VT inductions have a low yield in patients without baseline inducible VT and in the absence of clinical events. Definite recommendations regarding patient selection must await larger prospective studies as well as consensus in the medical community about what comprises an acceptable risk justifying avoidance of the costs and inconveniences of routine arrhythmia inductions.