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1、Deferred DFT testing at the time of cardiac resynchronization therapy is associated with poor long term outcome,Grace Lin, MD, Peter A. Brady, MD, David L. Hayes, MD Mayo Clinic, Rochester, MN USA,Background,Defibrillation threshold (DFT) testing is commonly performed at the time of ICD implantation
2、 In some cases DFT testing may not be performed, or deferred to a later date Impact of no or deferred DFT testing on outcome is unknown,Background,No or deferred DFT testing: Inadequate anticoagulation Hemodynamic instability Physician discretion Likelihood of no or deferred DFT testing may be highe
3、r in patients undergoing cardiac resynchronization therapy (CRT),Background,Prevalence and reasons of no or deferred DFT testing in patients undergoing CRT are unknown Outcome of CRT patients who undergo DFT testing vs. those who do not is unknown,Methods,All CRT-D implants from 1999-2004 at Mayo Cl
4、inic Review of Clinical record Operative note ICD database Clinical follow up via questionnaire,Methods,DFT+ DFT testing at implant DFT- DFT testing not at implant Delayed DFT Subsequent DFT testing DFT- never No subsequent DFT testing,Definitions,Results,Device Implants 1999-2004,Results,Baseline C
5、haracteristics,Results,Reasons for DFT-,Results,Reasons for DFT-,Survival,Months,P0.04,CP1207784-1,Survival in DFT + vs. DFT- Death or Transplantation,DFT+,DFT-,Results,Results,Baseline Characteristics for subsequent DFT testing,Results,Timing of delayed DFT testing: Mean 3.4 months +/- 5.7 Range of
6、 1 day to 26 months 13 patients tested 1 week after implantation,Results,Reasons for Delayed DFT,Results,Reasons for Delayed DFT,Results,Reasons for DFT- never,Results,Physician deferred (23),Severe CAD (12),Anticoagulation (3),Hypotension (3),Prolonged procedure(3),Malignant hyperthermia (1),LV pse
7、udoaneurysm (1),Survival,Months,P0.001,CP1207784-3,Survival Delayed DFT vs. DFT- Death or Transplantation,Delayed DFT,DFT- never,Survival,Months,p= 0.5,CP1207784-2,Delayed DFT,DFT +,Survival DFT + vs. Delayed DFT Death or Transplantation,Conclusions,Prevalence of no or deferred DFT testing in this p
8、opulation of patients is high (28%) Survival of patients who undergo DFT testing, whether at the time of implant or later, is similar and is significantly better than patients who never undergo DFT testing,Conclusions,Patients who do not undergo DFT testing at implant due to a reversible cause have similar outcomes to those who do undergo DFT testing at implant Implanting physician discretion regarding DFT testing at implant is an important determinant of outcome,