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Initial Clinical Experience with a Dual Lead Endocardial Defibrillation System with Atrial Pace/Sense Capability
Author(s) -
LUCERI RICHARD M,
ZILO PHILIP
Publication year - 1995
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1995.tb02497.x
Subject(s) - medicine , defibrillation , cardiology , lead (geology) , ventricular pacing , qrs complex , defibrillation threshold , coronary sinus , ejection fraction , surgery , heart failure , geomorphology , geology
Ninety‐three patients underwent implants of the Telectronics Model 4211 ICD attached to the Enguard PFX endocardial defibrillation lead system. Eighty‐one males and 12 females ranging in age from 25–85 years (mean= 64). Coronary disease was the substrate in the majority (88%); mean left ventricular ejection fraction was 30%. VT was present in 66%, VF in 22%, and both in7%, Three lead configurations were used in the study: ventriculo‐atrial (Ul, 86%); bidirectional (B2,12%); and ventricular to patch (U2, 2%). Mean RVpacing thresholds were 0.46 V preand 0.54 Vposttesting, with no significant differences between the two. Mean R wave voltage was 11.05 mVpreand 11.72 mV posttesting, also not significantly different. A subgroup of 13 patients had mean atrial pacing thresholds of 0.59 V at 0.5 msec pulse width, with mean P waves of 4.01 mV. Mean defibrillation threshold for the entire group was 10.6 J using biphasic waveforms. Defibrillation thresholds by configuration were: 399 V (U1);475 V(U2);and350 V(B2). All patients but one had thresholds ±550 V in at least one configuration. The 4211/Enguard system was implanted without (86%) or with (14%) a subcutaneous patch electrode. Early postoperative findings related to the ICD system include: one device circuit failure, one early lead dislodgement, and one pacing exit block. There were five patient deaths during the follow‐up period of 8.5 months: three cardiac nonsudden and two noncardiac. These data suggest that the 4211/Enguard defibrillation system can be successfully implanted in the majority of patients in need of such therapy.