Effect of defibrillation threshold testing-induced ventricular fibrillation on renal function

Abstract

The effect of defibrillation threshold (DFT) testing with induction of ventricular fibrillation (VF) on renal function is currently unknown. This study examined the acute effect of DFT testing on renal function in patients undergoing implantable cardioverter defibrillator (ICD) implantation. We performed a prospective cohort study of 148 consecutive patients who underwent ICD implantation from January 1, 2007 to May 30, 2008. Patients were assigned to one of two cohorts: a DFT group who underwent DFT testing at device implantation and a no-DFT group that was not tested. Baseline and 24-h postprocedure renal function were assessed with measurements of serum creatinine and estimated glomerular filtration rate (GFR) by the Modified Diet in Renal Disease equation. Changes in serum creatinine and estimated GFR were compared between cohorts. Ninety-eight patients (66%) underwent DFT testing (average VF induction count, 1.5 ± 0.9; mean VF duration, 10 ± 4 s). Fifty patients (34%) were not tested. Patients in the no-DFT group had lower mean left ventricular ejection fraction, higher New York Heart Association class, higher atrial fibrillation incidence, and greater intravenous contrast utilization at device implant. Baseline and postprocedure serum creatinine values were similar between groups (baseline, 1.25 ± 0.45 mg/dL; post-ICD, 1.26 ± 0.5 mg/dL). Baseline GFR was lower in the DFT cohort (55.2 ± 18.8 mL/min/BSA vs 63.7 ± 22.7 mL/min/BSA, p = 0.023). No significant differences between groups were observed in the mean change in serum creatinine or estimated GFR. DFT testing at the time of ICD implantation is not associated with acute adverse effects on renal function.