Optimization of atrial defibrillation with a dual-coil, active pectoral lead system.
INTRODUCTION: 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 t...
| Published in: | Journal of Cardiovascular Electrophysiology Vol. 15; no. 7; pp. 790 - 795 |
|---|---|
| Main Authors: | , , , |
| Format: | clinical trial research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Jul2004
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106648359&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106648359 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Jul2004 vid: 15 iid: 7 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 106648359 2005096217 10.1046/j.1540-8167.2004.03684.x NLM15250864 106648359 ppf: 790 ppct: 5 formats: fmt: @attributes: type: P tig: atl: Optimization of atrial defibrillation with a dual-coil, active pectoral lead system. aug: au: Rashba EJ Shorofsky SR Peters RW Gold MR affil: Division of Cardiology, University of Maryland School of Medicine, 22 South Greene Street, Room N3W77, Baltimore, MD 21201-1595; erashba@medicine.umaryland.edu sug: subj: Atrial Fibrillation Therapy Defibrillation Methods Defibrillators, Implantable Electrodes, Implanted Clinical Trials Data Analysis, Statistical Descriptive Statistics Maryland Prospective Studies Human ab: INTRODUCTION: 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. METHODS AND RESULTS: 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 shocking configurations were compared (3.6 +/- 3.0 J vs 3.4 +/- 2.9 J for ventricular and proximal triad, respectively, P = NS). Although shock impedance was reduced by 13% with the proximal triad (P < 0.001), this effect was offset by an increased current requirement (10%). CONCLUSION: The ventricular triad is equivalent or superior to other possible shocking pathways for atrial defibrillation afforded by a dual-coil, active pectoral lead system. Because the ventricular triad is also the most efficacious shocking pathway for ventricular defibrillation, this pathway should be preferred for combined atrial and ventricular defibrillators. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|