The objective of this project is to assess current clinical decision making regarding DFT testing during ICD implantation.
The ALIVE project collected data on DFT testing from a multicenter network of Italian clinicians sharing a common system for the collection, management, analysis, and reporting of clinical and diagnostic data from patients with Medtronic (Minneapolis, MN) implantable devices.
Data on 2,082 consecutive patients implanted with a Medtronic ICD in 111 Italian centers, over the period 2007 to 2010, were analyzed. Defibrillation threshold testing was performed in 33 % of cases (678/2,082). The main reasons for performing the test were physician's clinical practice (“I always perform DFT”) (80 % ) and secondary prevention implantation (12 % ). The main reasons for not performing DFT testing were centers' practice (44 % ), primary prevention (31 % ), and device replacement (15 % ). In 22 patients, ventricular fibrillation induction was not achieved; 656 patients completed DFT testing: 633 patients (96 % ) performed a single test, 19 patients (3 % ) performed a second induction test, and 4 patients (0.6 % ) underwent an additional induction test.
The preliminary results of the ALIVE project show that a great number of implant procedures are performed without DFT testing in the common practice of the participating centers. We also measured an inhomogeneous, center-dependent DFT testing behavior, which suggests the importance of defining a common guideline for ICD implant testing. Follow-up data on our patients will provide more information on the clinical value of the test.