Document Detail


Transvenous biventricular defibrillation.
MedLine Citation:
PMID:  11084104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The recent success of biventricular pacing with transvenously implantable left ventricular leads suggests that left ventricular leads may be useful for other modes of therapy. Animal studies showed small leads inserted into a left ventricular vein dramatically reduced defibrillation strength requirements. This article describes a human investigation of the feasibility of biventricular defibrillation. Fifty-one patients undergoing implantable cardioverter defibrillator (ICD) implantation were enrolled. After insertion of a standard ICD lead, a prototype over-the-wire left ventricular defibrillation lead was inserted through the coronary sinus and into a vein on the left ventricle. Lead insertion was guided by retrograde venography. The left ventricular lead's location was randomized to the anterior or posterior vein. Randomized, paired defibrillation threshold (DFT) testing was performed to compare a standard ICD shock configuration (Control: right ventricle- --> superior vena cava+ + CAN+) to 1 of 3 biventricular shock configurations. In the anterior vein, the left ventricular lead was tested with either a single biphasic shock from right ventricle + left ventricle- --> superior vena cava+ + CAN+ or a dual biphasic shock. In the posterior vein, the left ventricular lead was tested with a dual biphasic shock. Dual shocks consisted of a 40% tilt biphasic shock from right ventricle- --> superior vena cava+ + CAN+ followed by another 40% tilt biphasic shock from left ventricle- --> superior vena cava+ + CAN+, delivered from a single 225 microF capacitance. Left ventricular lead positioning was successful in 41 of 46 patients (89%). Mean left ventricular lead insertion time was 17 +/- 17 minutes and 13 +/- 15 minutes for anterior and posterior locations, respectively. Mean DFTs were not statistically lower for the left ventricular shock configurations, but retrospective analysis showed a well-defined region of the posterolateral left ventricle where consistent DFT reduction was achieved with dual shocks (14.0 +/- 2.7 J vs 7.8 +/- 0.9 J; n = 5; p = 0.04). There were no adverse events requiring intervention due to the use of the left ventricular lead. Biventricular defibrillation is feasible and safe under the conditions used in this study. Additional studies are needed to verify whether dual shocks with posterolateral left ventricular lead positions consistently reduce DFTs.
Authors:
E Meisel; C Butter; F Philippon; S Higgins; S A Strickberger; J Smith; S Hahn; U Michel; B Schubert; D Pfeiffer
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  86     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2005-11-04     Completed Date:  2005-12-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76K-85K     Citation Subset:  AIM; IM    
Affiliation:
Heart and Circulation Center, Dresden, Germany.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Vessels
Defibrillators, Implantable*
Electric Countershock / instrumentation*,  methods
Electrodes, Implanted
Feasibility Studies
Female
Humans
Male
Middle Aged
Prospective Studies
Tachycardia, Ventricular / therapy*
Veins
Ventricular Fibrillation / therapy*

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


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