Defibrillation Safety Margin Testing in Patients With Congenital Heart Disease: Results From the NCDR.

Abstract

OBJECTIVES:

This study analyzed the predictors of defibrillation safety margin (DSM) testing at the time of implantable cardioverter-defibrillator (ICD) insertion and factors associated with inadequate DSM in patients with congenital heart disease (CHD).

BACKGROUND:

There are few data about the prevalence and safety of DSM testing in those with CHD.

METHODS:

A retrospective analysis was performed of all patients with atrial or ventricular septal defect, tetralogy of Fallot, transposition of the great vessels, Ebstein anomaly, or common ventricle undergoing a transvenous ICD procedure in the National Cardiovascular Data Registry (NCDR) ICD Registry from April 2010 to March 2016, and DSM testing was assessed. Inadequate DSM was defined as a lowest successful energy tested <10 J than the maximum output of the ICD generator.

RESULTS:

Of all ICD recipients (N = 7,024), DSM testing was performed in 52.0% (n = 3,654). The mean lowest successful energy tested was 20.7 ± 7.3 J. Of those with DSM adequacy data available (n = 3,623), an inadequate DSM occurred in 13.8% (n = 501). After multivariable adjustment, DSM testing was not associated with in-hospital complications or death (odds ratio [OR]: 1.00; 95% confidence interval [CI]: 0.79 to 1.28) but was associated with lower odds of prolonged hospital stay (>3 days) (OR: 0.71; 95% CI: 0.60 to 0.84; p < 0.0001). An inadequate DSM was not associated with in-hospital death or complications (OR: 1.27; 95% CI: 0.79 to 2.04) or prolonged hospital stay (OR: 1.34; 95% CI: 0.995 to 1.81).

CONCLUSIONS:

DSM testing is being performed less frequently over time and seems safe in those with CHD. An inadequate DSM was not associated with worse in-hospital outcomes.

• Authors: Jordan M Prutkin, Yongfei Wang, Carolina A Escudero, Elizabeth A Stephenson, Karl E Minges, Jeptha P Curtis, Jonathan C Hsu
• Journal: JACC. Clinical electrophysiology (JACC Clin Electrophysiol) Vol. 7 Issue 9 Pg. 1145-1154 (09 2021) ISSN: 2405-5018 [Electronic] United States
• PMID: 33933411 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Defibrillators, Implantable
• Heart Defects, Congenital (therapy)
• Hospital Mortality
• Humans
• Registries
• Retrospective Studies