To Test or Not to Test During Defibrillator Implantation? A Reassessment of the Conventional Wisdom

摘要

From the inception of implantable cardioverter defibrilla-tors (ICDs), defibrillation testing has been conducted at the time of implantation. Initially, defibrillation testing was performed through implanted epicardial patches and an external defibrillator to test the efficacy of this arrangement in terminating ventricular fibrillation (VF). Testing in this manner assured the appropriateness of implanting a generator only after verifying successful defibrillation with the chosen lead configuration. The concept emerged of an adequate "safety margin" for defibrillation as an implant criterion, traditionally accepted as a defibrillation threshold (DFT) at least 10 J below the maximum energy of the device.With the introduction of endocardial leads, defibrillation testing remained an important aspect of implantation, as=15% patients were found to have high DFTs with monophasic shocks and required revision for new high-voltage coils or epicardial patches