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Related Experiment Videos

ICD waveform optimization: a randomized, prospective, pair-sampled multicenter study.

G Mouchawar1, M Kroll, J E Val-Mejias

  • 1St. Jude Medical, 15900 Valley View Court, Sylmar, CA 91342, USA. gabriel@pacesetter.com

Pacing and Clinical Electrophysiology : PACE
|January 5, 2001
PubMed
Summary
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Optimized biphasic waveforms for implantable cardioverter-defibrillators (ICDs) did not significantly differ from standard ones in defibrillation threshold (DFT) testing. However, tuned waveforms improved DFT in patients with high voltage requirements.

Area of Science:

  • Biomedical Engineering
  • Cardiovascular Research
  • Medical Device Technology

Background:

  • Current implantable cardioverter-defibrillator (ICD) biphasic waveforms utilize pulse widths longer than theoretically optimal.
  • Tissue modeling suggests shorter biphasic pulse durations may be more effective for defibrillation.

Purpose of the Study:

  • To identify optimal biphasic pulse widths using a tissue resistance/capacitance (RC) model.
  • To compare the efficacy of standard versus "tuned" biphasic waveforms in patients undergoing defibrillation threshold testing.

Main Methods:

  • A tissue RC model with a 3.5 ms time constant was used to define "tuned" waveform parameters.
  • Paired step-down defibrillation threshold (DFT) testing was performed in 91 patients comparing standard and tuned waveforms.

Related Experiment Videos

  • Multivariate analyses assessed relationships between DFT, impedance, and waveform parameters.

    • Main Results:

    • No significant differences in DFT or impedance were observed between standard and tuned waveforms in the overall patient group.
    • The "tuned" waveform significantly lowered DFT by 38 V in patients with baseline DFTs > 400 V (P < 0.05).
    • Higher impedance correlated inversely with DFT (P < 0.001), and the tuned waveform offered comparable DFT with reduced energy in these cases.

    Conclusions:

    • "Tuned" biphasic waveforms, optimized by RC modeling, show potential benefits for specific patient populations, particularly those with high DFTs.
    • This approach offers greater flexibility and potentially lower energy delivery for ICDs in patients with high impedance and defibrillation requirements.
    • Standard tilt values do not reliably predict ICD waveform efficacy.