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Introduction: This observational study is designed to address prospectively defined questions utilizing de-identified data obtained from the Boston Scientific LATITUDE remote monitoring system.We sought to determine the incidence of DFT testing in a naturalistic practice setting and to determine ifDFT testing predicts first spontaneous shock success for tachycardia events treated in the VF detection zone.Methods: We analyzed data from 81,081 ICD and CRT-D patients.42,785 stored EGM episodes prior to first shock VF therapy were available for review in 16,379 patients.We randomly sampled 2000 patients with a total of 5279 shock episodes between June 2001 and July 2008 according to a statistical plan.An adjudication committee reviewed all EGMs.Results: 70% of episodes were appropriate (monomorphic or polymorphic VT, VF) with an estimated incidence of 8% at 1 year.A total of 270 patients experienced VF with shock as a first therapy (mean age 63+/-13 years, 79%male, follow-up 38.7 +/-20 months).87% ofICD and CRT-D patients underwent DFT testing.First shock success for arrhythmias detected in the VF zone was not significantly higher for ICD or CRT D patients having DFT testing compared to those who did not.First shock energy was programmed lower in patients when a DFT testing was performed.There was a general trend toward less DFT testing in both the ICD and CRT D patients; however, there was a significant difference of less DFT testing in patients >80 years of age (p<.001) and those who received CRT D (p<.001).Smaller centers (10 or fewer implants) had significantly less DFT testing (p<.01).ICD DFT 6 month mortality was 2.33% vs 5.69% (no DFT) was significant (p<.001) as compared to CRT DFT 6 month mortality was 4.57% vs 6.23% (p=.102).Conclusion: In the largest patient cohort reported to date, DFT testing in a naturalistic EP practice still remains high however there is a trend to decreased DFT testing especially in patients over the age of 80 and in CRT D patients.Centers with higher implant volumes were more likely to perform DFTs.Patients who had DFT testing had lower programmed energies on average, shock success for terminating VF was similar between groups, in the worst case scenario (spontaneous VF).This lower programmed energy may result in a faster delivery of therapy lowering the likelihood of syncope during VF events.