Decline in Defibrillation Thresholds

Much research has been done to lower defibrillation thresholds (DFT) through improved waveforms and electrodes. We hypothesized that DFTs are declining steadily, as did pacing thresholds. We performed a meta‐analysis of 105 reports of DFTs from 58 articles and s published from 1973 to 1991. Human, d...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 1993-01, Vol.16 (1), p.213-217
Main Authors: KROLL, MARK W., ANDERSON, KENNETH M., SUPINO, C. GERARD, ADAMS, THEODORE P.
Format: Article
Language:English
Subjects:
Animals
defibrillation
Defibrillators, Implantable
Dogs
Electric Countershock
Electrodes, Implanted
Humans
leads
meta-analysis
Multivariate Analysis
Swine
thresholds
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Summary:Much research has been done to lower defibrillation thresholds (DFT) through improved waveforms and electrodes. We hypothesized that DFTs are declining steadily, as did pacing thresholds. We performed a meta‐analysis of 105 reports of DFTs from 58 articles and s published from 1973 to 1991. Human, dog, and pig studies were included. Transthoracic and isolated heart studies were excluded. Variables analyzed were: publication year, human study, epicardial electrodes only, multiple pathways (simultaneous or sequential), biphasic wave, subcutaneous patch, coronary sinus electrode, spring‐patch combination, and catheter‐based. DFTs are highly correlated with publication year (P = 0.013) and show an average drop of 0.75 joules/year by a linear univariate analysis. A linear multivariate analysis (r2= 0.51) gave six significant variables for the DFT: epicardial electrodes only, subcutaneous patch, biphasic wave, coronary sinus electrode (each decreased DFTs), and human subject and catheter‐based system (increased DFTs). Conclusions: DFTs have shown a decline over 18 years through electrode and waveform improvements. The practice of making devices with ever increasing energy ratings may eventually merit reexamination. The animal model is a useful predictor for clinical DFTs.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.1993.tb01564.x