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Body Surface Potentials During Discharge of the Implantable Cardioverter Defibrillator
Author(s) -
PETERS WERNER,
KOWALLIK PETER,
REISBERG MANFRED,
MEESMANN MALTE
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.tb01841.x
Subject(s) - medicine , cardiology , implantable cardioverter defibrillator , ventricular fibrillation , body surface area , shunt (medical) , body surface , defibrillation threshold , geometry , mathematics
Body Surface Potentials During ICD Discharge. Introduction: Little is known about the hazard for persons in contact with patients experiencing a high‐voltage discharge of their implantable cardioverter defibrillator (ICD). Compared to epicardial systems, this risk may be increased with transvenous electrode systems and particularly in active can configurations. Methods and Results: In 23 patients with a transvenous active can ICD system, body surface potentials V S and current through an external resistance were measured during 35 discharges. V S was detected using skin electrodes positioned over the left subpectorally implanted pulse generator [C], apex of the heart [A], and the right pectoral region [RP]. Mean V S during discharges without an external shunt resistance ranged between 13 and 63.8 V [C to A] and 12.5 to 47.3 V [C to RP] (ICD peak stored/output voltage V cap = 183 to 606 V, n = 20). Mean current flow [C to A] was 8.2 to 46.8 mA (V cap = 288 to 633 V. n = 10) and 42 to 120.7 mA (V cap = 447 to 579 V, n = 5) across a resistance of 1.696 and 797 ω, respectively. Conclusion: During high‐output shocks, a considerable potential difference is present on the hody surface of ICD patients that, according to the literature, may induce a single cardiac response in a bystander. Analogous to spontaneous extrasystoles, there is only a minimal chance of triggering a tachyarrhythmia by this stimulated extra beat. Direct induction of ventricular fibrillation is unlikely, since reported fibrillation threshold values are much higher than the ohserved magnitudes of current and voltage.