Predicting defibrillation outcome based on phase of ventricular activity during ICD implantation

Implantable cardioverter-defibrillators (ICDs) are well known medical device for patients who are at a risk of sudden cardiac death caused by ventricular fibrillation (VF). The relationship between VF mechanisms and successful ICD therapy to terminate of VF is still not well understood. The purpose of this work is to evaluate the timing of ICD therapy as a predictor of successful VF termination. Clinical data sets were recorded from the patients who underwent ICD implantation in 6 Canadian centers. Timing of the defibrillation attempt (phase) was analyzed by using the ICD Marker Channel which monitors and displays cardiac events sensed by ICD. Phase, based on the VF period, was divided into 10 equally distributed bins and number of successful defibrillation episodes in each bin was compared. A total of 187 defibrillation attempts were identified from the 65 subjects. 126 of the defibrillation attempts were successful, while 61 failed. The optimal case was observed at a phase value of 1.2pi with 2 successful attempts. The lowest performance rate was found at a phase value of 1.4pi and 1.8pi with 50% (3 and 2 successful attempts, respectively). The probability of success was analyzed by using generalized estimating equations (GEE) approach with an exchangeable correlation structure. The results of the GEE logistic regression model indicate no correlation between successful defibrillation attempts and phase of ventricular activity during VF (p-value = 0.78). From our results, timing of defibrillation shock attempt is not a factor in successful termination of VF for patients undergoing ICD implantation.