The Saga of Defibrillation Testing: When Less Is More

In the current era of implantable cardioverter-defibrillator procedures, the decision of whether or not to perform defibrillation threshold testing at the time of implantation is now less of a clinical conundrum. In this paper, we summarize this current practice, beginning with the physiology of defibrillation, followed by a review of the salient data, and discussion of specific situations where defibrillation threshold testing remains a clinical consideration.

Two prospective randomized trials demonstrated no mortality difference and no overall complication rate difference between patients who underwent defibrillation testing at implant compared with patients who underwent no defibrillation testing. Current recommendations support eliminating routine defibrillation testing in left-sided transvenous implantable cardioverter-defibrillator primary prevention implants. Defibrillation testing remains indicated in subcutaneous defibrillator implants in the absence of contraindications.