We hereby acknowledge that the National Institute on Drug Abuse (K01DA024760 to SAP) in part supported this work.
Effect of Substance Abuse on Defibrillation Threshold in Patients with Implantable Cardioverter-Defibrillator
Article first published online: 14 OCT 2010
©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 34, Issue 2, pages 193–199, February 2011
How to Cite
PERRINE, S. A., NAYAK, R., BHARADWAJ, A. S., MCKELVEY, G., MOHAMAD, T. and JACOB, S. (2011), Effect of Substance Abuse on Defibrillation Threshold in Patients with Implantable Cardioverter-Defibrillator. Pacing and Clinical Electrophysiology, 34: 193–199. doi: 10.1111/j.1540-8159.2010.02907.x
- Issue published online: 7 FEB 2011
- Article first published online: 14 OCT 2010
- Received March 20, 2010; revised May 8, 2010; accepted July 15, 2010.
- implantable cardioverter-defibrillator;
- defibrillation threshold;
- African American
Background: The use of recreational drugs has been observed to have deleterious effects on the heart. The aim of our study was to evaluate the effect of substance abuse on the defibrillation threshold (DFT) in patients with implantable cardioverter-defibrillators (ICDs).
Methods: A retrospective analysis was conducted on patients who had undergone ICD placement at a tertiary university medical center in Detroit, Michigan. Subjects were identified based on self-reported drug use and placed into one of the three groups: controls, cocaine, and other illicit drugs. Due to a disparity in race among groups, the main analysis on DFT value was conducted on African-American patients only. Furthermore, exploratory analyses were conducted to investigate the effects of marijuana use and race on DFT values.
Results: A history of cocaine use (n = 17) significantly increases DFT among African Americans (17.3 ± 8 Joule [J] vs 12.5 ± 5 J in cases vs controls, P < 0.05), while previous use of marijuana does not significantly influence DFT. African-American patients with a history of illicit drug use had indications for ICD implantation at an earlier age and that within the control (nondrug using) group; African Americans (n = 73) had higher DFT compared to Caucasians (n = 32), (14.5 ± 0.5 J vs 9.7 ± 0.6 J, P < 0.05).
Conclusions: A history of cocaine use in African Americans with ICD is a risk factor for high DFT and race itself (being African American) may be a risk for high DFT. Use of high-energy ICDs and other DFT lowering techniques may be considered for patients who have used or continue to use cocaine or in whom DFT testing cannot be performed at the time of implantation. (PACE 2011; 34:193–199)