Introduction: The incidence of ICD system modification after negative intraoperative defibrillation testing is recently around 5% (range 0 to 17%). The study goal was to evaluate, whether “schockless“ ICD implantation without intraoperative correction based on adverse test findings affects the rate of postoperative system revision.
Methods: In a prospective single-center observational study, 609 patients underwent transvenous ICD implantation without intraoperative testing. Defibrillation efficacy was validated prior to hospital discharge by applying two 10 J safety margin shocks.
Results: Postoperative device-related complications requiring surgical intervention occurred in 5 cases (0.8%): lead dislocation n = 3, increased pacing threshold n = 1, lead connection failure n = 1. The incidence of system modification was 4.8%: shock path reversal n = 23, implantation of a subcutaneous shock lead n = 6 (n = 4 (0.7%) for defibrillation failure, n = 2 for no safety margin). Compared to other clinical trials with intraoperative testing, “schockless” implantation did not result in an increased rate of postoperative revisions (tab. 1)
Conclusions: