A systematic evaluation of Conventional and novel transvenous pathways for defibrillation

• 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
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1023/A:1009895623802

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