Elevated defibrillation threshold despite programmable tilt, pulse width, or implant of subcutaneous coil: role of...

The value of defibrillation threshold testing (DFT) has been debated in recent years, especially with developments in the technology of manufactured defibrillators, most of which are capable of delivering high energies (35 Joules [J]) and have programmable features such as tilt percentage and pulse width duration that increase the efficiency of biphasic shocks. The following is an unusual case of elevated DFT despite all attempts of invasive and noninvasive approaches--it highlights the importance of performing DFT testing particularly when implantable cardioverter defibrillator is indicated for secondary prevention of sudden cardiac death and the need for devices capable of delivering higher energies >35 J.