Abstract 20242: Routine DFT Testing in Patients Undergoing ICD Implantation Does Not Improve Mortality: A Systematic Review & Meta-Analysis

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A20242
• Main Authors: Kannabhiran, Munish, Acharya, Madan, Telles, Nelson, Brackett, Alexandria, Reddy, Pratap, Dominic, Paari
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11.11.2016
• ISSN: 0009-7322; 1524-4539

IntroductionTraditionally, Defibrillation threshold (DFT) testing has been an integral part of implantable cardioverter-defibrillator (ICD) implantation to confirm appropriate sensing of ventricular fibrillation and to establish an adequate safety margin for defibrillation. However, there is lack of evidence behind routine DFT testing. Therefore, we performed a meta-analysis to assess its mortality benefit.HypothesisRoutine DFT testing improves mortality.MethodsWe searched MEDLINE for all studies comparing mortality outcomes in ICD recipients who underwent DFT testing to those who did not. For the second analysis, studies comparing outcomes in high versus low energy DFT were included. Odds ratio and standard errors were calculated and inverse variance method in a random effect model was used to combine effect sizes.ResultsFourteen studies with 10,762 subjects comparing outcomes in patients who underwent routine DFT testing during ICD implantation and those who did not were included. There was no statistically significant difference in the group that did not undergo DFT testing with regards to all-cause mortality(OR 0.936;CI 0.717-1.221;p-0.625), cardiac mortality(OR 0.709;CI 0.385-1.307;p-0.271), non-cardiac mortality(OR 0.921;CI 0.701-1.210;p-0.554) and arrhythmic mortality(OR 1.152;CI 0.831-1.596;p-0.396). Percentage of successful appropriate first shocks among the two groups showed no difference. Five studies with 2278 subjects were included in the second analysis comparing patients with low DFT versus high DFT. Patients with high DFT had no significant increase in all-cause mortality compared to patients with low DFT (OR 0.527;CI 0.034-8.107;p-0.646)ConclusionsPatients requiring higher DFT had no increased all-cause mortality compared to patients with lower DFT. DFT testing during ICD implantation does not confer any significant benefit.