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Defibrillation testing is not required during routine ICD implantation.

Sudden cardiac death (SCD) is a major cause of mortality throughout the world, accounting for ∼300 000 deaths per year in the USA.1 The introduction of the implantable cardioverter defibrillator (ICD) in the 1980s significantly reduced the risk of SCD by terminating life-threatening ventricular tachyarrhythmias.2 Subsequent clinical trials confirmed the survival benefit with implanted ICDs in at-risk cardiac patients.3,4 Since the beginning, defibrillation threshold (DFT) testing has been an integral part of the ICD implantation procedure to ascertain detection and termination of ventricular tachyarrhythmias. DFT testing often involves multiple ventricular fibrillation (VF) induction and defibrillation, imposing a significant burden on the implanting team and, foremost, the patient. However, the view on the routine use of DFT testing has been challenged by a recent investigation on DFT testing during ICD implantation.5

In this issue of the journal, Bansch et al .6 present another prospective, randomized, parallel group, multicentre non-inferiority trial, NORDIC ICD, designed to test the hypothesis that shock efficacy during follow-up is not impaired in …