Current Practice in Italy of VF Testing at Implant: What Do We Know and Where Do We Go From Here?
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The standardized requirements for cardioverter defibrillator (ICD) implantation, with or without cardiac resynchronization therapy (CRT), include defibrillation testing (DT), which consists of the induction and termination of ventricular fibrillation (VF). This procedure has been followed from the early days of ICD therapy in order to assess the reliability of an implanted ICD device and to measure the defibrillation threshold. Effective DT is considered mandatory in accordance with the rules
... ce with the rules of good clinical practice. Nowadays, since the implantation procedure for ICDs has become markedly simplified and the surgical risk is very low, DT can be considered to be the most critical part of the implantation procedure itself. Although the risk associated with DT is usually low, serious complications may nonetheless occur as a consequence of this practice. Complications include transient ischemic attack or stroke, cardiopulmonary arrest due to refractory VF or pulseless electrical activity, cardiogenic shock, embolic events, and death. This knowledge comes from small single-center retrospective surveys  and from anecdotal experience. However, in the absence of data from large populations enrolled in multi-center registries, the real magnitude of intraoperative complications related to DT is still largely unknown. Although the standardized approach to ICD implantation still includes a VF induction test, data coming from real-world experience suggest that an increasing number of first-implantation procedures are performed without