Patient-tailored implantable cardioverter defibrillator testing using the upper limit of vulnerability: the TULIP protocol

• Published in: Europace (London, England) Vol. 10; no. 8; pp. 907 - 913
• Main Authors: Lemke, Bernd, Lawo, Thomas, Zarse, Markus, Lubinski, Andrzej, Kreutzer, Ulrich, Mueller, Johannes, Schuchert, Andreas, Mitzenheim, Sabine, Danilovic, Dejan, Deneke, Thomas
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2008; Oxford Publishing Limited (England)
• Subjects: Algorithms; Defibrillators, Implantable; Equipment Design; Equipment Failure Analysis - methods; Feasibility Studies; Female; Humans; Male; Middle Aged; Therapy, Computer-Assisted - methods; Treatment Outcome; Ventricular Fibrillation - rehabilitation; Implantation; Defibrillation threshold; Upper limit of vulnerability; Implantable cardioverter defibrillator; Ventricular fibrillation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eun136

Aims We evaluated the feasibility of the TULIP (Threshold test using Upper Limit during ImPlantation) protocol, which was designed to provide a confirmed, low defibrillation energy value during implantable cardioverter defibrillator (ICD) implantation with only two induced ventricular fibrillation (VF) episodes. Methods and results Ninety-eight patients (62 ± 12 years, 86 male) from 13 clinical centres underwent an active can ICD implantation. A single coupling interval derived from electrocardiogram lead II during ventricular pacing was used for VF induction shocks at 13, 11, 9, and 6 J in a step-down manner until the upper limit of VF induction (ULVI) was determined. If ULVI ≥9 J, a defibrillation energy of ULVI + 4 J was tested. For ULVI <9 J, the defibrillation test energy was 9 J. In 79/98 patients (80.6%), two induced VF episodes were sufficient to obtain confirmed defibrillation energy of 11.1 ± 3.3 J. The mean strength of the successful VF induction shock was 6.8 ± 4.3 J, the coupling interval was 303 ± 35 ms, and the number of delivered induction shocks until the first VF induction was 3.9 ± 1.6. Conclusion TULIP is a safe and simple device testing procedure allowing the determination of confirmed, low defibrillation energy in most patients with two VF episodes induced at a single coupling interval.