[Is intraoperative ICD-testing still necessary?]

Area of Science:

• Cardiology
• Biomedical Engineering

Context:

• Intraoperative testing of implantable cardioverter-defibrillators (ICDs) is a traditional practice to ensure device efficacy.
• Advancements in defibrillator technology have improved sensing, detection, and defibrillation capabilities.

Purpose:

• To review the arguments for and against routine intraoperative defibrillation threshold testing in all patients receiving ICDs.
• To evaluate the necessity of current testing protocols in light of technological progress.

Summary:

• Current ICDs are highly effective, defibrillating most patients at implant.
• Factors such as patient condition, cardiac disease severity, ischemia, medication, and ICD system specifics (lead type/placement) complicate testing.
• Testing methods carry a risk of false negatives, as the a priori probability of a positive test result is over 95%.

Impact:

• Suggests that routine intraoperative ICD testing may be an outdated practice.
• Highlights the need for prospective randomized studies to establish evidence-based guidelines for ICD testing.
• Advocates for moving away from traditional testing protocols towards a more personalized, evidence-driven approach.