Defibrillation testing in everyday medical practice during implantable cardioverter defibrillator implantation in France: analysis from the LEADER registry

Abstract

Background: Defibrillation testing (DT) is usually performed during implantable cardioverter defibrillator (ICD) implantation.

Aims: We conducted a multicentre prospective study to determine the DT procedures used in everyday practice, to compare the characteristics of patients with or without DT, and to compare severe adverse events in these two populations during implantation and follow-up.

Methods: The LEADER registry enrolled 904 patients included for primo-implantation of a single (n=261), dual (n=230) or triple (n=429) defibrillation system in 42 French centres.

Results: Baseline characteristics of patients (62.0 ± 13.5 years; 88% men; primary indication 62%) who underwent ventricular fibrillation (VF) induction (VF induction group, n=810) and those who did not (untested group, n=94, representing 10.4% of the entire study population) revealed that the untested group were older (P<0.01), had a lower left ventricular ejection fraction, a wider QRS complex and a higher New York Heart Association class and were more often implanted for primary prevention (P<0.001 for all). The main reason given for not performing ICD testing was poor haemodynamic condition (59/94). At 1 year, the cumulative survival rate was 95% in tested patients and 85% in untested patients (P<0.001), mainly because of heart failure deaths. There was one sudden cardiac death in the VF induction group and none in the untested group (P=1.000).

Conclusions: In this study, more than 10% of ICD patients were implanted without VF induction. Untested patients appeared to be sicker than tested patients, with a more severe long-term outcome, but without any difference in mortality due to arrhythmic events.

Keywords: AF; Atrial fibrillation; DFT; DT; Defibrillation testing; Defibrillation threshold; Défibrillateur automatique implantable; ICD; Implantable cardioverter defibrillator; LVEF; Left ventricular ejection fraction; Marge de sécurité; NYHA; New York Heart Association; Safety margin; Single chamber defibrillator; Tachyarythmie ventriculaire; Test de défibrillation; VVI; Ventricular tachyarrhythmia.