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Related Experiment Video

Updated: Jun 23, 2026

A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique
09:47

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Published on: April 26, 2015

Defibrillation threshold testing: tradition or necessity?

Christof Kolb1, Stylianos Tzeis, Bernhard Zrenner

  • 1Deutsches Herzzentrum, 1. Medizinische Klinik rechts der Isar, Faculty of Medicine, Technische Universität München, München, Germany. kolb@dhm.mhn.de

Pacing and Clinical Electrophysiology : PACE
|May 9, 2009
PubMed
Summary

Routine defibrillation threshold (DFT) testing for implantable cardioverter defibrillators (ICDs) may pose risks outweighing benefits. Emerging data suggest DFT testing prevents minimal mortality, questioning its necessity in ICD procedures.

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Published on: February 28, 2012

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Last Updated: Jun 23, 2026

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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
16:40

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

Published on: February 28, 2012

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death.
  • Defibrillation threshold (DFT) testing is a traditional part of ICD implantation procedures.

Purpose of the Study:

  • To evaluate the risk-benefit balance of routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation.
  • To assess the impact of DFT testing on mortality reduction in primary and secondary prevention of sudden cardiac death.

Main Methods:

  • Analysis of data from primary and secondary prevention trials for sudden cardiac death.
  • Calculation of the number of patients needed to undergo DFT testing to prevent one death.
  • Assessment of the risks associated with DFT testing, including life-threatening complications and procedural mortality.

Main Results:

  • The absolute mortality reduction from ICDs is approximately 8% in primary and 7% in secondary prevention.
  • The likelihood of an inadequate DFT with high-energy ICDs is about 2.5%, necessitating DFT testing in ~500 patients to avert one death.
  • Antitachycardia pacing reduces the need for reliable ICD defibrillation, lowering preventable mortality by DFT testing to below 0.2%.

Conclusions:

  • The risk of life-threatening complications (0.4%) and procedural mortality associated with DFT testing may outweigh the minimal mortality benefit.
  • The balance between risks and benefits suggests that routine DFT testing might not be justified.
  • Prospective randomized trials are needed to definitively determine if routine DFT testing can be abandoned.