Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can

Charles D. Swerdlow, Scott Davie, Robert M. Kass, Peng-Sheng Chen, Chun Hwang, William J. Mandel, Eli S. Gang, Sharo Raissi, C. Thomas Peter

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

A new 83 cm3 implantable cardioverter-defibrillator (ICD) designed for pectoral implantation has been implanted most frequently usina right ventricular and superior vena cava (RV → SVC) electrodes; a patch electrode (RV → patch + SVC) has been added when necessary to decrease the defibrillation threshold (DFT). The goal of this prospective study was to compare biphasic waveform DFTs for 3 electrode configurations: RV → patch, RV → SVC, and RV → pafch + SVC in 25 consecutive patients. The patch was positioned in a left retropectoral pocket, and the SVC electrode was positioned with the tip at the junction of the SVC and innominate vein. In the first 15 patients, all 3 electrode configurations were tested in random order; in the last 10 patients, only the RV → patch and RV → patch + SVC configurations were tested. In the first 15 patients, the stored-energy DFT for the RV → SVC configuration (15.2 ± 7.7 J) was higher (p <0.001) than the DFT for the RV → patch configuration (11.3 ± 6.2 J) and the RV → patch + SVC configuration (10.0 ± 5.8 J). For all 25 patients, the DFT was lower for the RV → patch + SVC configuration (9.7 ± 5.1 J) than for the RV → patch configuration (12.4 ± 6.6 J, p = 0.005). The pathway resistance was highest for the RV → patch configuration (72 ± 9 Ω), lower for the RV → SVC configuration (63 ± 6 Ω, p <0.01), and lowest for the RV → patch + SVC configuration (46 ± 3 Ω, p <0.001). The addition of an SVC electrode to the RV → patch configuration reduced the DFT substantially for high-resistance RV → patch pathways (>73 Ω: 13.0 ± 8.4 vs 8.3 ± 5.6 J, p <0.005), but not for low-resistance RV → patch pathways (>73 Ω: 11.7 ± 4.9 vs 11.0 ± 4.5 J, p = NS). Overall, the DFT was ≥ 20 J in 6 of 15 patients (40%) with the RV → SVC configuration, in 4 of 25 patients (16%) with the RV → patch configuration, and in none of 25 patients (0%) with the RV → patch + SVC configuration. All 25 RV → patch and RV → patch + SVC configurations met the implant criterion, but 3 of the 15 RV → SVC configurations (20%) did not. For this ICD, electrode configurations that include a patch provide the lowest DFTs. An additional SVC electrode lowers the DFT only if the resistance of the RV → patch pathway is high.

Original languageEnglish (US)
Pages (from-to)370-374
Number of pages5
JournalThe American Journal of Cardiology
Volume76
Issue number5
DOIs
StatePublished - Aug 15 1995
Externally publishedYes

Fingerprint

Defibrillators
Superior Vena Cava
Electrodes
Implantable Defibrillators
Brachiocephalic Veins
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can. / Swerdlow, Charles D.; Davie, Scott; Kass, Robert M.; Chen, Peng-Sheng; Hwang, Chun; Mandel, William J.; Gang, Eli S.; Raissi, Sharo; Peter, C. Thomas.

In: The American Journal of Cardiology, Vol. 76, No. 5, 15.08.1995, p. 370-374.

Research output: Contribution to journalArticle

Swerdlow, Charles D. ; Davie, Scott ; Kass, Robert M. ; Chen, Peng-Sheng ; Hwang, Chun ; Mandel, William J. ; Gang, Eli S. ; Raissi, Sharo ; Peter, C. Thomas. / Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can. In: The American Journal of Cardiology. 1995 ; Vol. 76, No. 5. pp. 370-374.
@article{9324ce07c9db4b3183d940efd4ba0bdf,
title = "Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can",
abstract = "A new 83 cm3 implantable cardioverter-defibrillator (ICD) designed for pectoral implantation has been implanted most frequently usina right ventricular and superior vena cava (RV → SVC) electrodes; a patch electrode (RV → patch + SVC) has been added when necessary to decrease the defibrillation threshold (DFT). The goal of this prospective study was to compare biphasic waveform DFTs for 3 electrode configurations: RV → patch, RV → SVC, and RV → pafch + SVC in 25 consecutive patients. The patch was positioned in a left retropectoral pocket, and the SVC electrode was positioned with the tip at the junction of the SVC and innominate vein. In the first 15 patients, all 3 electrode configurations were tested in random order; in the last 10 patients, only the RV → patch and RV → patch + SVC configurations were tested. In the first 15 patients, the stored-energy DFT for the RV → SVC configuration (15.2 ± 7.7 J) was higher (p <0.001) than the DFT for the RV → patch configuration (11.3 ± 6.2 J) and the RV → patch + SVC configuration (10.0 ± 5.8 J). For all 25 patients, the DFT was lower for the RV → patch + SVC configuration (9.7 ± 5.1 J) than for the RV → patch configuration (12.4 ± 6.6 J, p = 0.005). The pathway resistance was highest for the RV → patch configuration (72 ± 9 Ω), lower for the RV → SVC configuration (63 ± 6 Ω, p <0.01), and lowest for the RV → patch + SVC configuration (46 ± 3 Ω, p <0.001). The addition of an SVC electrode to the RV → patch configuration reduced the DFT substantially for high-resistance RV → patch pathways (>73 Ω: 13.0 ± 8.4 vs 8.3 ± 5.6 J, p <0.005), but not for low-resistance RV → patch pathways (>73 Ω: 11.7 ± 4.9 vs 11.0 ± 4.5 J, p = NS). Overall, the DFT was ≥ 20 J in 6 of 15 patients (40{\%}) with the RV → SVC configuration, in 4 of 25 patients (16{\%}) with the RV → patch configuration, and in none of 25 patients (0{\%}) with the RV → patch + SVC configuration. All 25 RV → patch and RV → patch + SVC configurations met the implant criterion, but 3 of the 15 RV → SVC configurations (20{\%}) did not. For this ICD, electrode configurations that include a patch provide the lowest DFTs. An additional SVC electrode lowers the DFT only if the resistance of the RV → patch pathway is high.",
author = "Swerdlow, {Charles D.} and Scott Davie and Kass, {Robert M.} and Peng-Sheng Chen and Chun Hwang and Mandel, {William J.} and Gang, {Eli S.} and Sharo Raissi and Peter, {C. Thomas}",
year = "1995",
month = "8",
day = "15",
doi = "10.1016/S0002-9149(99)80103-9",
language = "English (US)",
volume = "76",
pages = "370--374",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can

AU - Swerdlow, Charles D.

AU - Davie, Scott

AU - Kass, Robert M.

AU - Chen, Peng-Sheng

AU - Hwang, Chun

AU - Mandel, William J.

AU - Gang, Eli S.

AU - Raissi, Sharo

AU - Peter, C. Thomas

PY - 1995/8/15

Y1 - 1995/8/15

N2 - A new 83 cm3 implantable cardioverter-defibrillator (ICD) designed for pectoral implantation has been implanted most frequently usina right ventricular and superior vena cava (RV → SVC) electrodes; a patch electrode (RV → patch + SVC) has been added when necessary to decrease the defibrillation threshold (DFT). The goal of this prospective study was to compare biphasic waveform DFTs for 3 electrode configurations: RV → patch, RV → SVC, and RV → pafch + SVC in 25 consecutive patients. The patch was positioned in a left retropectoral pocket, and the SVC electrode was positioned with the tip at the junction of the SVC and innominate vein. In the first 15 patients, all 3 electrode configurations were tested in random order; in the last 10 patients, only the RV → patch and RV → patch + SVC configurations were tested. In the first 15 patients, the stored-energy DFT for the RV → SVC configuration (15.2 ± 7.7 J) was higher (p <0.001) than the DFT for the RV → patch configuration (11.3 ± 6.2 J) and the RV → patch + SVC configuration (10.0 ± 5.8 J). For all 25 patients, the DFT was lower for the RV → patch + SVC configuration (9.7 ± 5.1 J) than for the RV → patch configuration (12.4 ± 6.6 J, p = 0.005). The pathway resistance was highest for the RV → patch configuration (72 ± 9 Ω), lower for the RV → SVC configuration (63 ± 6 Ω, p <0.01), and lowest for the RV → patch + SVC configuration (46 ± 3 Ω, p <0.001). The addition of an SVC electrode to the RV → patch configuration reduced the DFT substantially for high-resistance RV → patch pathways (>73 Ω: 13.0 ± 8.4 vs 8.3 ± 5.6 J, p <0.005), but not for low-resistance RV → patch pathways (>73 Ω: 11.7 ± 4.9 vs 11.0 ± 4.5 J, p = NS). Overall, the DFT was ≥ 20 J in 6 of 15 patients (40%) with the RV → SVC configuration, in 4 of 25 patients (16%) with the RV → patch configuration, and in none of 25 patients (0%) with the RV → patch + SVC configuration. All 25 RV → patch and RV → patch + SVC configurations met the implant criterion, but 3 of the 15 RV → SVC configurations (20%) did not. For this ICD, electrode configurations that include a patch provide the lowest DFTs. An additional SVC electrode lowers the DFT only if the resistance of the RV → patch pathway is high.

AB - A new 83 cm3 implantable cardioverter-defibrillator (ICD) designed for pectoral implantation has been implanted most frequently usina right ventricular and superior vena cava (RV → SVC) electrodes; a patch electrode (RV → patch + SVC) has been added when necessary to decrease the defibrillation threshold (DFT). The goal of this prospective study was to compare biphasic waveform DFTs for 3 electrode configurations: RV → patch, RV → SVC, and RV → pafch + SVC in 25 consecutive patients. The patch was positioned in a left retropectoral pocket, and the SVC electrode was positioned with the tip at the junction of the SVC and innominate vein. In the first 15 patients, all 3 electrode configurations were tested in random order; in the last 10 patients, only the RV → patch and RV → patch + SVC configurations were tested. In the first 15 patients, the stored-energy DFT for the RV → SVC configuration (15.2 ± 7.7 J) was higher (p <0.001) than the DFT for the RV → patch configuration (11.3 ± 6.2 J) and the RV → patch + SVC configuration (10.0 ± 5.8 J). For all 25 patients, the DFT was lower for the RV → patch + SVC configuration (9.7 ± 5.1 J) than for the RV → patch configuration (12.4 ± 6.6 J, p = 0.005). The pathway resistance was highest for the RV → patch configuration (72 ± 9 Ω), lower for the RV → SVC configuration (63 ± 6 Ω, p <0.01), and lowest for the RV → patch + SVC configuration (46 ± 3 Ω, p <0.001). The addition of an SVC electrode to the RV → patch configuration reduced the DFT substantially for high-resistance RV → patch pathways (>73 Ω: 13.0 ± 8.4 vs 8.3 ± 5.6 J, p <0.005), but not for low-resistance RV → patch pathways (>73 Ω: 11.7 ± 4.9 vs 11.0 ± 4.5 J, p = NS). Overall, the DFT was ≥ 20 J in 6 of 15 patients (40%) with the RV → SVC configuration, in 4 of 25 patients (16%) with the RV → patch configuration, and in none of 25 patients (0%) with the RV → patch + SVC configuration. All 25 RV → patch and RV → patch + SVC configurations met the implant criterion, but 3 of the 15 RV → SVC configurations (20%) did not. For this ICD, electrode configurations that include a patch provide the lowest DFTs. An additional SVC electrode lowers the DFT only if the resistance of the RV → patch pathway is high.

UR - http://www.scopus.com/inward/record.url?scp=0029128807&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029128807&partnerID=8YFLogxK

U2 - 10.1016/S0002-9149(99)80103-9

DO - 10.1016/S0002-9149(99)80103-9

M3 - Article

VL - 76

SP - 370

EP - 374

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -