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Effect of a Single Element Subcutaneous Array Electrode Added to a Transvenous Electrode Configuration on the Defibrillation Field and the Defibrillation Threshold
Author(s) -
KÜHLKAMP VOLKER,
DÖRNBERGER VOLKER,
KHALIGHI* KOUROSH,
MEWIS CHRISTIAN,
SUCHALLA RALPH,
ZIEMER* GERHARD,
SEIPEL LUDGER
Publication year - 1998
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.1540-8159.1998.tb00036.x
Subject(s) - medicine , defibrillation , lead (geology) , defibrillation threshold , subclavian vein , transvenous pacing , cardiology , surgery , catheter , geomorphology , geology
Even with the use of biphasic shocks, up to 5% of patients need an additional subcutaneous lead to obtain a defibrillation safety margin of at least 10 J. The number of patients requiring additional subcutaneous leads may even increase, because recent generation devices have a < 34 J maximum output in order to decrease their size. In 20 consecutive patients, a single element subcutaneous array lead was implanted in addition to a transvenous lead system consisting of a right ventricular (RV) and a vena cava superior lead using a single infraclavicular incision. The RV lead acted as the cathode; the subcutaneous lead and the lead in the subclavian vein acted as the anode. The biphasic defibrillation threshold was determined using a binary search protocol. Patients were randomized as to whether to start them with the transvenous lead configuration or the combination of the transvenous lead and the subcutaneous lead. In addition, a simplified assessment of the defibrillation field was performed by determining the interelectrode area for the transvenous lead only and the transvenous lead in combination with the subcutaneous lead from a biplane chest X ray. The intraoperative defibrillation threshold was reconfirmed after 1 week, after 3 months, and after 12 months. The mean defibrillation threshold with the additional subcutaneous lead was significantly (P = 0.0001) lower (5.7 ± 2.9 J) than for the transvenous lead system (9.5 ± 4.6 J). With the subcutaneous lead, the impedance of the high voltage circuit decreased from 48.9 ± 7.4 Ω to 39.2 ± 5.0 Ω. In the frontal plane, the interelectrode area increased by 11.3%± 5.5% (P < 0.0001) and in the lateral plane by 29.5%± 12.4% (P < 0.0001). The defibrillation threshold did not increase during follow‐up. Complications with the subcutaneous electrode were not observed during a follow‐up of 15.8 ± 2 months. The single finger array lead is useful in order to lower the defibrillation threshold and can be used in order to lower the defibrillation threshold.