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Influence of Body Position on Defibrillation Thresholds of Nonthoracotomy Implantable Defibrillators:
Author(s) -
SCHAUERTE PATRICK,
DIEM BJÖRN,
ZIEGERT KATHRIN,
FRANKE ANDREAS,
HANRATH PETER,
STELLBRINK CHRISTOPH
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb00956.x
Subject(s) - supine position , medicine , defibrillation threshold , defibrillation , body position , shock (circulatory) , cardiology , anesthesia , physical medicine and rehabilitation
DFT of Nonthoracotomy Defibrillators. Introduction : Defibrillation thresholds (DFTs) usually are determined with the patient in the supine position. However, patients may be in the upright position when a shock is delivered during follow‐up, which may explain some first shock failures observed clinically. This study investigated whether body posture affects defibrillation energy requirements of nonthoracotomy implantable cardioverter defibrillators with biphasic shocks. Methods and Results : Using a step up‐down protocol, DFTs were compared intraindividually in 52 patients (“active‐can” systems in 41 patients, two‐lead systems in II patients) for the supine and upright positions as achieved by a tilt table. The mean DFT was 7.3 ± 4.2 J in the supine versus 9.2 ± 4.8 J in the upright position (P = 0.002). Repeated comparison in reversed order 3 months after implantation in 22 patients revealed thresholds of 6.2 ± 2.5 J (supine) versus 8.4 ± 3.7 J (upright; P < 0.03) 1 week and 4.4 ± 2.4 J (supine) versus 6.2 ± 4.1 J (upright; P < 0.04) 3 months after implantation. DFTs decreased significantly for both body positions from 1 week to 3 months after implantation (P < 0.04). Conclusion :(I) DFTs for biphasic shocks delivered by nonthoracotomy defibrillators are higher in the upright compared to the supine body position. (2) Differences remain significant 3 months after implantation. For both body positions, DFT decreases significantly from 1 week to 3 months after implantation. These findings have important implications for programming first shock energy to lower than maximal values or for development of devices with lower maximal stored energy.