Arrhythmias & electrophysiology
Ventricular Fibrillation Conversion Testing After Implantation of a Subcutaneous Implantable Cardioverter Defibrillator: Report From the National Cardiovascular Data Registry
Authors' conclusion
Use of CT testing after S-ICD implantation was driven by facility preference to a greater extent than patient factors and was not associated with a composite of inhospital complications or death. ISM was relatively uncommon and is associated with several widely available patient characteristics.
Study context
- Population
- First-time S-ICD recipients, NCDR ICD Registry, September 28, 2012 to April 1, 2016
- Participants
- 7,960 recipients
- Exposure
- VF conversion testing vs no testing after S-ICD implantation
- Conversion testing (CT)n = 5,624
- Outcome
- Predictors of use of CT, predictors of insufficient safety margin (ISM, VF conversion energy >65J) and in-hospital outcomes associated with CT
Methodological detailsregistry-based, inverse probability weighted
- Registry-based
- Inverse probability weighted
Main finding
As reported in the abstract
Use of CT
CT
70.7%
5624
- AUC for patient level vs generalized linear mixed model (facility effect)
- 0.619 versus 0.877
Observational data: associations, not effects.
Further findings
Insufficient safety margin (ISM) (patients without prior ICD)
- ISM incidence
- 6.9% (n=336) of 4864
- More common among white patients and those with ventricular pacing on preimplant ECG, higher preimplant BP, larger body surface area, higher BMI, lower EF
- Risk score identified low (<5%), medium (5% to 10%) and high risk (>10%) for ISM
Safety
- CT not associated with composite of in-hospital complications including death
- Inverse probability weighted
Original publication
Ventricular Fibrillation Conversion Testing After Implantation of a Subcutaneous Implantable Cardioverter Defibrillator: Report From the National Cardiovascular Data Registry. Circulation. Published 20 February 2018. doi:10.
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