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

15 Scopus citations

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Swerdlow, C. D., Davie, S., Kass, R. M., Chen, P. S., Hwang, C., Mandel, W. J., Gang, E. S., Raissi, S., & Peter, C. T. (1995). Optimal electrode configuration for pectoral transvenous intplantable defibrillator without an active can. The American journal of cardiology, 76(5), 370-374. https://doi.org/10.1016/S0002-9149(99)80103-9