Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation
<p><strong>Introduction:</strong> There is an ongoing debate regarding the need to conduct intraoperative defibrillation testing (DFT) at the time of implantable cardioverter-defibrillator (ICD) implantation. To provide sufficiently strong evidence for the feasibility of omitting i...
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Shahid Beheshti University of Medical Sciences
2017-11-01
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doaj-63dd1635eb2e41f7a04d7351b1841f7b2020-11-25T00:36:23ZengShahid Beheshti University of Medical SciencesInternational Journal of Cardiovascular Practice2476-71742476-468X2017-11-0124808810.21859/ijcp-0301059560Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator ImplantationCarlo Bonanno0Antonio Rossillo1Mariemma Paccanaro2Angelo Ramondo3Antonio Raviele4Cardiology, S. Bortolo Hospital Viale Rodolfi, 37 36100, Vicenza (Italy)Cardiology, S. Bortolo Hospital Viale Rodolfi, 37 36100, Vicenza (Italy)Cardiology, S. Bortolo Hospital Viale Rodolfi, 37 36100, Vicenza (Italy)Cardiology, S. Bortolo Hospital Viale Rodolfi, 37 36100, Vicenza (Italy)Alliance to Fight Atrial Fibrillation Via Torino, 151/c 30174 Mestre–Venice (Italy)<p><strong>Introduction:</strong> There is an ongoing debate regarding the need to conduct intraoperative defibrillation testing (DFT) at the time of implantable cardioverter-defibrillator (ICD) implantation. To provide sufficiently strong evidence for the feasibility of omitting intraoperative DFT in clinical practice, we conducted a meta-analysis of randomized controlled trials (RCT) comparing patients with DFT and no-DFT.</p><p><br /><strong>Methods:</strong> We systematically searched Medline (via PubMed), ClinicalTrial.gov, the Cochrane Central Register of Controlled Trials, and Embase for studies evaluating DFT vs. no-DFT on ICD implantation with regard to total mortality and arrhythmic death, efficacy of first and any appropriate shock in interrupting ventricular tachycardia (VT)/ventricular fibrillation (VF), and procedural adverse events. Effect estimates [risk ratio (RR) with 95% confidence intervals (CI)] were pooled using the random-effects model.</p><p><br /><strong>Results:</strong> Our meta-analysis included 4 RCTs comprising 3770 patients (1896 with DFT and 1874 without DFT). Total mortality (RR = 1.00, 95% CI 0.86–1.17; P = 0.98) and arrhythmic death (RR = 1.60, 95% CI 0.46-5.59: P = 0.46) were not statistically different. Both first (RR = 0.94, 95% CI 0.89–0.98; P = 0.004) and any appropriate ICD shock (RR = 0.97, 95% CI 0.95–1.00; P = 0.02) significantly increased the rate of VT/VF interruption in the group with no-DFT in comparison with DFT. Finally, the incidence of adverse events was lower in no-DFT patients (RR = 1.23; 95% CI 1.00–1.51; P = 0.05).</p><p><br /><strong>Conclusions:</strong> The practice of DFT (as opposed to no-DFT) did not yield benefits in mortality or the overall rate of conversion of VT/VT. Moreover, a slightly higher incidence of perioperative adverse events was observed in the DFT group.</p>http://journals.sbmu.ac.ir/ijcp/article/view/18368 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carlo Bonanno Antonio Rossillo Mariemma Paccanaro Angelo Ramondo Antonio Raviele |
spellingShingle |
Carlo Bonanno Antonio Rossillo Mariemma Paccanaro Angelo Ramondo Antonio Raviele Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation International Journal of Cardiovascular Practice |
author_facet |
Carlo Bonanno Antonio Rossillo Mariemma Paccanaro Angelo Ramondo Antonio Raviele |
author_sort |
Carlo Bonanno |
title |
Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation |
title_short |
Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation |
title_full |
Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation |
title_fullStr |
Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation |
title_full_unstemmed |
Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation |
title_sort |
updated meta-analysis of randomized trials comparing safety and efficacy of intraoperative defibrillation testing with no defibrillation testing on implantable cardioverter-defibrillator implantation |
publisher |
Shahid Beheshti University of Medical Sciences |
series |
International Journal of Cardiovascular Practice |
issn |
2476-7174 2476-468X |
publishDate |
2017-11-01 |
description |
<p><strong>Introduction:</strong> There is an ongoing debate regarding the need to conduct intraoperative defibrillation testing (DFT) at the time of implantable cardioverter-defibrillator (ICD) implantation. To provide sufficiently strong evidence for the feasibility of omitting intraoperative DFT in clinical practice, we conducted a meta-analysis of randomized controlled trials (RCT) comparing patients with DFT and no-DFT.</p><p><br /><strong>Methods:</strong> We systematically searched Medline (via PubMed), ClinicalTrial.gov, the Cochrane Central Register of Controlled Trials, and Embase for studies evaluating DFT vs. no-DFT on ICD implantation with regard to total mortality and arrhythmic death, efficacy of first and any appropriate shock in interrupting ventricular tachycardia (VT)/ventricular fibrillation (VF), and procedural adverse events. Effect estimates [risk ratio (RR) with 95% confidence intervals (CI)] were pooled using the random-effects model.</p><p><br /><strong>Results:</strong> Our meta-analysis included 4 RCTs comprising 3770 patients (1896 with DFT and 1874 without DFT). Total mortality (RR = 1.00, 95% CI 0.86–1.17; P = 0.98) and arrhythmic death (RR = 1.60, 95% CI 0.46-5.59: P = 0.46) were not statistically different. Both first (RR = 0.94, 95% CI 0.89–0.98; P = 0.004) and any appropriate ICD shock (RR = 0.97, 95% CI 0.95–1.00; P = 0.02) significantly increased the rate of VT/VF interruption in the group with no-DFT in comparison with DFT. Finally, the incidence of adverse events was lower in no-DFT patients (RR = 1.23; 95% CI 1.00–1.51; P = 0.05).</p><p><br /><strong>Conclusions:</strong> The practice of DFT (as opposed to no-DFT) did not yield benefits in mortality or the overall rate of conversion of VT/VT. Moreover, a slightly higher incidence of perioperative adverse events was observed in the DFT group.</p> |
url |
http://journals.sbmu.ac.ir/ijcp/article/view/18368 |
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