递延密度泛函理论在心脏再同步治疗时间地测试与长期贫困地结果.pptVIP

Deferred DFT testing at the time of cardiac resynchronization therapy is associated with poor long term outcome Grace Lin, MD, Peter A. Brady, MD, David L. Hayes, MD Mayo Clinic, Rochester, MN USA Background Defibrillation threshold (DFT) testing is commonly performed at the time of ICD implantation In some cases DFT testing may not be performed, or deferred to a later date Impact of no or deferred DFT testing on outcome is unknown Background No or deferred DFT testing: Inadequate anticoagulation Hemodynamic instability Physician discretion Likelihood of no or deferred DFT testing may be higher in patients undergoing cardiac resynchronization therapy (CRT) Background Prevalence and reasons of no or deferred DFT testing in patients undergoing CRT are unknown Outcome of CRT patients who undergo DFT testing vs. those who do not is unknown Methods All CRT-D implants from 1999-2004 at Mayo Clinic Review of Clinical record Operative note ICD database Clinical follow up via questionnaire Methods DFT+ DFT testing at implant DFT- DFT testing not at implant Delayed DFT Subsequent DFT testing DFT- never No subsequent DFT testing Results Results Results Results Results Results Results Timing of delayed DFT testing: Mean 3.4 months +/- 5.7 Range of 1 day to 26 months 13 patients tested 1 week after implantation Results Results Results Results Conclusions Prevalence of no or deferred DFT testing in this population of patients is high (28%) Survival of patients who undergo DFT testing, whether at the time of implant or later, is similar and is significantly better than patients who never undergo DFT testing Conclusions Patients who do not undergo DFT testing at implant due to a reversible cause have similar outcomes to those who do undergo DFT testing at implant Implanting physician discretion regarding DFT testing at implant is an important determinant of outcome * Definitions 277 CRT-D implants 14 pts lost to follow up 263 pts included 192 DFT+ (tested)