Document Detail


Lack of benefit of an active pectoral pulse generator on atrial defibrillation thresholds.
MedLine Citation:
PMID:  12033348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Atrial defibrillation can be achieved with standard implantable cardioverter defibrillator leads, which has led to the development of combined atrial and ventricular devices. For ventricular defibrillation, use of an active pectoral electrode (active can) in the shocking pathway markedly reduces defibrillation thresholds (DFTs). However, the effect of an active pectoral can on atrial defibrillation is unknown. METHODS AND RESULTS: This study was a prospective, randomized, paired comparison of two shock configurations on atrial DFTs in 33 patients. The lead system evaluated was a dual-coil transvenous defibrillation lead with a left pectoral pulse generator emulator. Shocks were delivered either between the right ventricular coil and proximal atrial coil (lead) or between the right ventricular coil and an active can in common with the atrial coil (active can). Delivered energy at DFT was 4.2 +/- 4.1 J in the lead configuration and 5.0 +/- 3.7 J in the active can configuration (P = NS). Peak current was 32% higher with an active can (P < 0.01), whereas shock impedance was 18% lower (P < 0.001). Moreover, a low threshold (< or = 3 J) was observed in 61% of subjects in the lead configuration but in only 36% in the active can configuration (P < 0.05). There were no clinical predictors of the atrial DFT. CONCLUSION: These results indicate that low atrial DFTs can be achieved using a transvenous ventricular defibrillation lead. Because no benefit was observed with the use of an active pectoral electrode for atrial defibrillation, programmable shock vectors may be useful for dual-chamber implantable cardioverter defibrillators.
Authors:
Michael R Gold; Stephen R Shorofsky; Rachida Bouhouch; Robert A Joy; D Scott Kirby; Ahmed F Osman; Eric J Rashba
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  13     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-05-29     Completed Date:  2002-12-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  332-5     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Medical University of South Carolina, Charleston 29425, USA. Goldmr@musc.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / physiopathology*,  therapy*
Defibrillators, Implantable*
Differential Threshold
Electric Countershock / instrumentation,  methods*
Electrodes, Implanted
Female
Heart Rate
Humans
Male
Middle Aged
Pectoralis Muscles
Sensitivity and Specificity
Treatment Outcome
Ventricular Fibrillation / physiopathology,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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