Does defibrillation threshold increase as left ventricular ejection fraction decreases?

Abstract

Aims Advanced cardiac disease, entailing more hypertrophy, fibrosis, scarring, dilatation and conduction delays, poses the question of whether defibrillation thresholds (DFTs) increase as left ventricular ejection fraction (LVEF) decreases. This question has been approached indirectly or insufficiently in previous studies. In this study we add and expand on our previous work, stratifying DFT for various LVEF ranges. Methods and results This retrospective analysis included DFT data from three acute, multicentre, randomized studies that included 230 ICD/CRT-D patients. All DFTs were obtained with the SVC coil turned ON and with pulse-width optimized waveforms based on a 3.5 ms membrane time constant. As the LVEF decreased, DFT estimates increased from 395.2 ± 115 V for LVEF ≥ 46% to 425.8 ± 117.6 V for LVEF ≤ 25%. However, these changes in DFT estimates were very minor and not statistically significant. Only 3% of the patients in this population had an elevated DFT of >20 J. Conclusion This analysis shows that over a very broad range of LVEF, DFT changes minimally (approximately 1 J), if at all. Our results are consistent with previous studies that demonstrated no difference in the DFT estimates: (a) between patient groups receiving ICD (typically higher LVEF) vs. CRT-D (typically lower LVEF) and (b) between patient groups receiving a device for primary prevention indications (typically lower LVEF) vs. secondary prevention indications (typically higher LVEF).