EP News: Allied Professionals

Abstract

Using data from the National Cardiovascular Data Registry (NCDR), Friedman et al (Circulation 2018;[Epub ahead of print], PMID 29463509) sought to assess the use and safety of ventricular fibrillation (VF) conversion testing during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. The authors noted that VF conversion testing has a Class I indication, but there are reports of declining compliance with this testing. They used the registry data on all S-ICD implantations between September 28, 2012 (when the S-ICD was approved by the Food and Drug Administration), and April 1, 2016 (when VF conversion testing results were no longer reported in NCDR), to predict use of VF conversion testing, clinical characteristics of insufficient safety margin (ISM), and in-hospital outcomes. ISM was defined as the lowest amount of energy required to convert VF >65 J during the procedure. The value recorded in the NCDR is the final value, as there is no way to record whether there was ISM during procedure that led to intraprocedure device revision. Therefore, it is possible that ISM occurs at higher rates and can be mitigated by device revision, such as repositioning of the lead or can.