Optimization of atrial defibrillation with a dual-coil, active pectoral lead system

Journal of Cardiovascular Electrophysiology
Eric J RashbaMichael R Gold

Abstract

Atrial defibrillation can be achieved with standard implantable cardioverter defibrillator (ICD) leads, but the optimal shocking configuration is unknown. The objective of this prospective study was to compare atrial defibrillation thresholds (DFTs) with three shocking configurations that are available with standard ICD leads. This study was a prospective, randomized, paired comparison of shocking configurations on atrial DFTs in 58 patients. The lead system evaluated was a transvenous defibrillation lead with coils in the superior vena cava (SVC) and right ventricular apex (RV) and a left pectoral pulse generator emulator (Can). In the first 33 patients, atrial DFT was measured with the ventricular triad (RV --> SVC + Can) and unipolar (RV --> Can) shocking pathways. In the next 25 patients, atrial DFT was measured with the ventricular triad and the proximal triad (SVC --> RV + Can) configurations. Delivered energy at DFT was significantly lower with the ventricular triad compared to the unipolar configuration (4.7 +/- 3.7 J vs 10.1 +/- 9.5 J, P < 0.001). Peak voltage and shock impedance also were significantly reduced (P < 0.001). There was no significant difference in DFT energy when the ventricular triad and proximal triad ...Continue Reading

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Citations

Jan 11, 2012·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Jörg Neuzner, Jörg Carlsson
Aug 9, 2008·Annals of Biomedical Engineering·Fei Yang, Robert Patterson
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May 30, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Eric J RashbaMichael R Gold

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