Outcome and safety of intraoperative defibrillation testing during device replacement: the Simpler trial

Anat Milman*, Eyal Nof, Moshe Rav Acha, Roy Beinart, Valentina Kutyifa, Béla Merkely, Ehud Regev, Mauro Biffi, Yong Mei Cha, Tal Ovdat, Robert Klempfner, Michael Glikson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Aims Intraoperative defibrillation testing (DT) during implant or replacement of implantable cardioverter-defibrillators (ICDs) has been a matter of debate for many years. This debate was put to rest by the Simple and Nordic ICD trials, and the practice of testing during new implantations has essentially been almost abandoned. Old registries demonstrated an increased incidence of significant findings in DT during replacements. The aim of the present study was to evaluate frequency of significant findings and safety of DT in subjects undergoing device replacement. Methods A prospective observational multi-centre study included consecutive patients undergoing ICD generator replacement. The and results primary outcome was a failure to terminate induced ventricular fibrillation (VF) with a single shock 10 J below the maximal capacity of the device. Secondary outcomes included complications of DT. Patients were followed-up at 1- and 6-months post-procedure. A total of 92 patients were eligible, and consented to the study, of which 84 underwent DT during battery replacement. The median age was 68 years and 79.8% were males. Induction of VF was successful in 84 patients as was a successful conversion on the first attempt in all. There were no procedure-related complications. During follow up one patient had two appropriate ICD shock events. In four patients, ICD programming was changed. None suffered inappropriate shock. There was no evidence of lead malfunction. Two deaths occurred, none of which was related to arrhythmia. Conclusion The present study found DT was not associated with complications in patients undergoing ICD generator replacement but produced no clinically important information.

Original languageEnglish
Pages (from-to)956-960
Number of pages5
JournalEuropace
Volume25
Issue number3
DOIs
StatePublished - 1 Mar 2023

Keywords

  • Defibrillation testing
  • Device replacement
  • Implantable cardioverter-defibrillators
  • Safety
  • Ventricular fibrillation

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