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Transvenous biventricular defibrillation
E Meisel1, C Butter, F Philippon
1Heart and Circulation Center, Dresden, Germany.
The American Journal of Cardiology
|November 21, 2000
Summary
Biventricular defibrillation using left ventricular leads is feasible and safe. While not consistently reducing defibrillation thresholds, specific posterolateral placements showed significant reductions in animal studies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Biventricular pacing success suggests potential for left ventricular leads in other therapies.
- Animal studies indicated reduced defibrillation strength requirements with left ventricular leads.
Purpose of the Study:
- To investigate the feasibility and safety of biventricular defibrillation in humans.
- To compare defibrillation threshold (DFT) reduction using standard versus biventricular shock configurations.
Main Methods:
- Fifty-one patients undergoing implantable cardioverter defibrillator (ICD) implantation were enrolled.
- A prototype left ventricular defibrillation lead was inserted via the coronary sinus.
- Randomized DFT testing compared standard ICD shocks to three biventricular configurations.
Main Results:
- Left ventricular lead positioning was successful in 89% of patients.
- Mean DFTs were not significantly lower across all biventricular configurations.
- Retrospective analysis revealed significant DFT reduction (p=0.04) with dual shocks in the posterolateral left ventricle.
Conclusions:
- Biventricular defibrillation is feasible and safe in the tested configurations.
- Further studies are required to confirm consistent DFT reduction with posterolateral left ventricular lead placement.