A systematic evaluation of Conventional and novel transvenous pathways for defibrillation

Conventional implantable cardioverter defibrillators employ endocardial (shock) electrodes with a lead located in the right ventricular apex (RV) and a "hot-can" electrode located subcutaneously in the left pectoral region. In the event of a high defibrillation threshold (DFT) a third elec...

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Bibliographic Details
Published in:Journal of interventional cardiac electrophysiology 1999-10, Vol.3 (3), p.231-238
Main Authors: ROBERTS, P. R, ALLEN, S, SMITH, D. C, URBAN, J. F, EULER, D. E, DAHL, R. W, KALLOK, M. J, MORGAN, J. M
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Defibrillators, Implantable
Disease Models, Animal
Diseases of the cardiovascular system
Electric Countershock - methods
Female
Heart Rate
Medical sciences
Pulmonary Artery
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Random Allocation
Swine
Vena Cava, Inferior
Vena Cava, Superior
Ventricular Fibrillation - physiopathology
Ventricular Fibrillation - therapy
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Summary:Conventional implantable cardioverter defibrillators employ endocardial (shock) electrodes with a lead located in the right ventricular apex (RV) and a "hot-can" electrode located subcutaneously in the left pectoral region. In the event of a high defibrillation threshold (DFT) a third electrode is frequently employed in the superior vena cava (SVC). We report the comparison of conventional and novel locations of additional electrodes with the RV/Can configuration, in a porcine model. In 12 anesthetized pigs (30-45 kg), endocardial defibrillation electrodes were randomized to the following locations: RV/Can, RV/Can + SVC, RV/Can + main pulmonary artery (MPA) and RV/Can + left pulmonary artery wedge position (PAW), RV/Can + high inferior vena cava (HIVC), RV/Can + Low inferior vena cava (LIVC). Ventricular fibrillation (VF) was induced using 60 Hz alternating current. After 10 seconds VF a rectangular biphasic shock was delivered by the ARD9000 (Angeion Corp). The DFT was determined for each configuration using a modified four-reversal binary search. All configurations were compared using a repeated measures analysis of variance (ANOVA) statistical test and the five 3-electrode configurations were compared to the RV/Can position using a Dunnett test. Mean DFTs: RV = 21.5 +/- 4.8 J, SVC = 16.8 +/- 4.7 J (p < 0.05 vs. RV), HIVC = 21.1 +/- 4.7 J (p
ISSN:1383-875X
1572-8595
DOI:10.1023/A:1009895623802