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The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://content.onlinejacc.org/cgi/content/full/52/7/557
Of the 16 patients with a DFT between 21 and 30 J, only information is gained as a result of the procedure in most
3 patients had an appropriate shock in follow-up, all of patients; the observation that spontaneous arrhythmias are
which were successful. Granted, this is a small number of often ventricular tachycardia, which is easier to cardiovert;
patients and events. However, there were over 700 patients and the fact that DFT testing is not without risk, among
in this substudy, with a median follow-up of 45.5 months. others.
The 2.2% risk of an elevated DFT is comparable to what has These observations coupled with the results of the present
been seen in other studies. With that low level of risk for a study indicate that routine DFT testing in stable patients
high DFT, and a markedly lower risk of an adverse outcome receiving nonresynchronization ICDs for primary preven-
in follow-up, a much larger study with a prolonged tion is of little clinical value. Driven by these results, it
follow-up would need to be done to detect a difference in would be reasonable to consider whether practice guidelines
outcome, if indeed one exists. Whether such a slight should be revised to reflect these findings, with 2 important
difference in outcome would be clinically meaningful is also caveats. First, a mounting consensus that routine DFT
questionable. testing may be safely abandoned in selected patients does
It should be noted that defibrillation using shock energies not mean that it should be discontinued in all patients. We
up to 30 J was successful in all patients in this substudy. It do not have information on patients receiving cardiac
is thus unknown what kind of outcome might be expected resynchronization devices and other specific situations as
in patients who failed defibrillation with the maximum mentioned previously to make recommendations at this
output of an ICD at the time of implantation. However, it time. However, proof-of-concept has now been established
is clear that in patients similar to those tested in SCD- that routine DFT testing is unlikely to provide sufficient
HeFT, that finding would be exceedingly rare. information that impacts ICD programming in the over-
It is important to stress that the results of this study can whelming majority of patients, and it carries some slight
be applied only to similar patients who are receiving risk. Collectively, these data justify a prospective trial
single-chamber ICDs for primary prevention and are receiv- randomizing patients receiving ICDs for any indication to
ing standard-of-care background medical therapy for heart DFT testing versus no DFT testing, because less testing just
failure. The results should not be extrapolated to patients might be more than enough.
receiving cardiac resynchronization therapy, who often have
more advanced disease. Whether the results could be Reprint requests and correspondence: Dr. Anne B. Curtis,
applied to patients receiving dual-chamber ICDs is debat- University of South Florida, 12901 Bruce B. Downs Boulevard,
able because the reason for the atrial lead may be a history MDC 87, Tampa, Florida 33612. E-mail: acurtis@health.usf.edu.
of atrial arrhythmias or a rare need for pacing that may not
have an impact on defibrillation. The results should also not REFERENCES
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spontaneous ventricular fibrillation in follow-up; the reality Key Words: sudden cardiac death y implantable
that successful DFT testing at implant is so likely that little cardioverter-defibrillator y defibrillation y ventricular fibrillation.