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Title: Patient-tailored implantable cardioverter defibrillator testing using the upper limit of vulnerability: the TULIP protocol.
Author: Lemke B, Lawo T, Zarse M, Lubinski A, Kreutzer U, Mueller J, Schuchert A, Mitzenheim S, Danilovic D, Deneke T, Threshold test using Upper Limit during ImPlantation Study Group.
Journal: Europace; 2008 Aug; 10(8):907-13. PubMed ID: 18515789.
Abstract:
AIMS: We evaluated the feasibility of the TULIP (Threshold test using Upper Limit during ImPlantation) protocol, which was designed to provide a confirmed, low defibrillation energy value during implantable cardioverter defibrillator (ICD) implantation with only two induced ventricular fibrillation (VF) episodes. METHODS AND RESULTS: Ninety-eight patients (62 +/- 12 years, 86 male) from 13 clinical centres underwent an active can ICD implantation. A single coupling interval derived from electrocardiogram lead II during ventricular pacing was used for VF induction shocks at 13, 11, 9, and 6 J in a step-down manner until the upper limit of VF induction (ULVI) was determined. If ULVI >or=9 J, a defibrillation energy of ULVI + 4 J was tested. For ULVI <9 J, the defibrillation test energy was 9 J. In 79/98 patients (80.6%), two induced VF episodes were sufficient to obtain confirmed defibrillation energy of 11.1 +/- 3.3 J. The mean strength of the successful VF induction shock was 6.8 +/- 4.3 J, the coupling interval was 303 +/- 35 ms, and the number of delivered induction shocks until the first VF induction was 3.9 +/- 1.6. CONCLUSION: TULIP is a safe and simple device testing procedure allowing the determination of confirmed, low defibrillation energy in most patients with two VF episodes induced at a single coupling interval.

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