Lead System Optimization for Transvenous Defibrillation

• Published in: The American journal of cardiology 1997-11, Vol.80 (9), p.1163-1167
• Main Authors: Gold, Michael R, Foster, Andrew H, Shorofsky, Stephen R
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiovascular disease; Defibrillators, Implantable; Diseases of the cardiovascular system; Electric Countershock - methods; Electrodes, Implanted; Equipment Design; Female; Heart; Humans; Male; Medical equipment; Medical sciences; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Ventricular Fibrillation - prevention & control
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(97)00633-4

Lead systems that include an active pectoral shell reduce defibrillation thresholds and permit transvenous defibrillation in nearly all patients. A further improvement in defibrillation efficacy is desirable to allow for smaller pulse generators with a reduced maximum output. Accordingly, the purpose of this study was to compare defibrillation thresholds with multiple transvenous lead systems including those with an active pectoral shell to determine which system would optimize defibrillation energy requirements. This prospective study was performed on 21 consecutive patients. Each subject was evaluated with 3 lead configurations with the order of testing randomized. The configurations were a dual coil transvenous lead (lead), the distal right ventricular coil and pectoral pulse generator shell (unipolar), and all 3 components (triad). The right ventricular coil was the cathode for the first phase of the biphasic defibrillation waveform. Delivered energy at defibrillation threshold was 11.2 ± 3.4 J for the lead configuration, 10.1 ± 5.2 J for the unipolar configuration, and 7.8 ± 3.6 J for the triad configuration (p