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Related Experiment Videos

Increased defibrillation threshold with right-sided active pectoral can.

P R Roberts1, S Allen, T Betts

  • 1Department of Electrophysiology, Wessex Cardiothoracic Centre, Southampton University Hospitals, United Kingdom.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|March 24, 2000
PubMed
Summary

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Placing the active can in the right pectoral position for implantable cardioverter defibrillators significantly increases defibrillation thresholds compared to other chest wall locations. Left-sided positions do not significantly impact defibrillation effectiveness.

Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Implantable cardioverter defibrillators (ICDs) are crucial for treating life-threatening arrhythmias.
  • Optimal lead and device placement is essential for effective defibrillation.
  • The active can's position on the chest wall may influence defibrillation thresholds (DFT).

Purpose of the Study:

  • To determine the optimal chest wall position for the active can of a two-electrode ICD system.
  • To compare DFTs with the active can placed in four different submuscular locations.

Main Methods:

  • Defibrillation thresholds (DFT) were measured in 10 anesthetized pigs.
  • A transvenous right ventricular electrode and a submuscular active can were used.
  • The active can was implanted in left pectoral, right pectoral, left lateral, and apex positions, with DFTs measured via binary search after induced ventricular fibrillation.

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Main Results:

  • The right pectoral (RP) position showed a significantly higher DFT (18.8+/- 4.2 J) compared to left pectoral (LP, 14.6+/- 4.0 J), left lateral (LL, 14.7+/- 4.1 J), and apex (A, 14.9+/- 3.1 J) positions.
  • RP placement increased DFT by 29% compared to other sites.
  • No significant difference in DFT was observed between LP, LL, and A positions.

Conclusions:

  • Submuscular implantation of the active can in the right pectoral position is suboptimal for defibrillation efficacy.
  • Left-sided thoracic can placement does not significantly influence DFT.
  • These findings suggest that left pectoral or apex positions may be preferable for active can placement in ICD systems.